{"id":2269,"date":"2022-07-13T23:07:08","date_gmt":"2022-07-13T16:07:08","guid":{"rendered":"https:\/\/ykhoataynguyen.com\/site\/?p=2269"},"modified":"2022-07-14T22:42:47","modified_gmt":"2022-07-14T15:42:47","slug":"tai-lieu-de-cuong-soan-noi-co-so","status":"publish","type":"post","link":"https:\/\/ykhoataynguyen.com\/site\/tai-lieu-de-cuong-soan-noi-co-so\/","title":{"rendered":"\u0110\u1ec1 c\u01b0\u01a1ng N\u1ed9i c\u01a1 s\u1edf, K14 (Tham kh\u1ea3o)"},"content":{"rendered":"

 <\/p>\n

T\u00f3m t\u1eaft (Gi\u1edbi h\u1ea1n):<\/p>\n

Kh\u00e1m b\u1ec7nh tim m\u1ea1ch
\n– tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng trong th\u0103m kh\u00e1m tim
\n– c\u01a1 ch\u1ebf c\u1ee7a 7 ti\u1ebfng tim th\u01b0\u1eddng g\u1eb7p khi nghe tim
\n– c\u01a1 ch\u1ebf g\u00e2y ra ti\u1ebfng th\u1ed5i \u1edf tim
\n– m\u00f4 t\u1ea3 ti\u1ebfng tim khi nghe tim trong th\u0103m kh\u00e1m h\u1ec7 tim m\u1ea1ch
\n– ph\u00e2n \u0111\u1ed9 ti\u1ebfng th\u1ed5i \u1edf tim
\n– ph\u00e2n bi\u1ec7t ti\u1ebfng th\u1ed5i c\u01a1 n\u0103ng v\u00e0 ti\u1ebfng th\u1ed5i th\u1ef1c th\u1ec3
\n– c\u1eadn l\u00e2m s\u00e0ng th\u0103m d\u00f2 tim
\n– kh\u00e1m l\u00e2m s\u00e0ng \u0111\u1ed9ng m\u1ea1ch
\n– kh\u00e1m l\u00e2m s\u00e0ng t\u0129nh m\u1ea1ch
\nH\u1ed9i ch\u1ee9ng suy tim
\n– nguy\u00ean nh\u00e2n
\n– tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng
\n– ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh
\n– ch\u1ea9n \u0111o\u00e1n th\u1ec3
\n– ph\u00e2n \u0111\u1ed9
\n– ph\u00e2n giai \u0111o\u1ea1n
\n– bi\u1ebfn ch\u1ee9ng
\n\u0110au B\u1ee5ng
\n– nguy\u00ean nh\u00e2n
\n– c\u00e1ch kh\u00e1m l\u00e2m s\u00e0ng
\nV\u00e0ng Da
\n– nguy\u00ean nh\u00e2n
\n– ch\u1ea9n \u0111o\u00e1n
\nGan To
\n– nguy\u00ean nh\u00e2n
\n– c\u00e1ch kh\u00e1m l\u00e2m s\u00e0ng
\nC\u1ed5 Tr\u01b0\u1edbng
\n– nguy\u00ean nh\u00e2n
\n– c\u00e1ch kh\u00e1m LS
\nTh\u0103m Kh\u00e1m H\u1ec7 Ti\u1ebft Ni\u1ec7u
\n– kh\u00e1m th\u1ef1c th\u1ec3 th\u1eadn, ni\u1ec7u qu\u1ea3n v\u00e0 b\u00e0ng quang
\n\u0110\u00e1i M\u00e1u
\n-nguy\u00ean nh\u00e2n
\n– ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, ch\u1ea9n \u0111o\u00e1n v\u1ecb tr\u00ed
\nPh\u00f9
\n– th\u0103m kh\u00e1m ph\u00f9
\n-ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t ph\u00f9 do b\u1ec7nh th\u1eadn v\u00e0 ph\u00f9 do suy tim
\nTh\u0103m Kh\u00e1m H\u1ec7 H\u00f4 H\u1ea5p
\n– c\u00e1ch kh\u00e1m h\u1ec7 h\u00f4 h\u1ea5p b\u1eb1ng nh\u00ecn s\u1edd g\u00f5 nghe
\nTranf D\u1ecbch M\u00e0ng Ph\u1ed5i
\n– nguy\u00ean nh\u00e2n
\n– l\u00e2m s\u00e0ng, CLS
\nTh\u0103m kh\u00e1m h\u1ec7 n\u1ed9i ti\u1ebft
\n-LS, CLS
\n– kh\u00e1m bn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng
\nKh\u1edbp- Th\u1ea7n kinh
\n– kh\u00e1m LS vi\u00eam kh\u1edbp
\n– \u0111\u1ea5u hi\u1ec7u hoffmann v\u00e0 Babinski
\n– nguy\u00ean nh\u00e2n h\u00f4n m\u00ea
\n– ph\u00e2n \u0111\u1ed9 h\u00f4n m\u00ea
\n\u0110\u00e1i m\u00e1u
\n– \u0111\u1ecbnh ngh\u0129a
\n– nguy\u00ean nh\u00e2n
\nXu\u1ea5t huy\u1ebft
\n– \u0111\u1ecbnh ngh\u0129a
\n– nguy\u00ean nh\u00e2n
\nL\u00e1ch -H\u1ea1ch to
\n– c\u00e1ch kh\u00e1m, nguy\u00ean nh\u00e2n<\/p>\n

C\u00e2u 1:C\u01a1 ch\u1ebf & ph\u00e2n \u0111\u1ed9 ti\u1ebfng th\u1ed5i \u1edf tim. Ph\u00e2n bi\u1ec7t ti\u1ebfng th\u1ed5i c\u01a1 n\u0103ng, th\u1ef1c th\u1ec3 khi nghe tim ?<\/p>\n

C\u00e2u 2 : Tr\u00ecnh b\u00e0y kh\u00e1m l\u00e2m s\u00e0ng m\u1ea1ch m\u00e1u trong th\u0103m kh\u00e1m h\u1ec7 tim m\u1ea1ch ?<\/p>\n

C\u00e2u 3: nguy\u00ean nh\u00e2n , tri\u1ec7u ch\u1ee9ng, ch\u1ea9n \u0111o\u00e1n suy tim<\/p>\n

C\u00e2u 4 : Tr\u00ecnh b\u00e0y ph\u00e2n \u0111\u1ed9 v\u00e0 G\u0110 suy tim theo NYHA, h\u1ed9i tim m\u1ea1ch Ch\u00e2u \u00c2u v\u00e0 theo LS ?<\/p>\n

C\u00e2u 5: Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng c\u1ee7a b\u1ec7nh tim?<\/p>\n

C\u00e2u 6: C\u01a1 ch\u1ebf ti\u1ebfng T1, T2, T3 v\u00e0 T4 khi nghe ti\u1ebfng tim?<\/p>\n

C\u00e2u 7: Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n, ch\u1ea9n \u0111o\u00e1n bi\u1ebfn ch\u1ee9ng ST<\/p>\n

C\u00e2u 8: Tri\u1ec7u ch\u00fang l\u00e2m s\u00e0ng khi nghe tim h\u1eb9p van 2 l\u00e1 v\u00e0 h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7?<\/p>\n

C\u00e2u 9: Tr\u00ecnh b\u00e0y nguy\u00ean nh\u00e2n tri\u1ec7u ch\u1ee9ng suy tim tr\u00e1i ?<\/p>\n

C\u00e2u 10: Tr\u00ecnh b\u00e0y nguy\u00ean nh\u00e2n tri\u1ec7u ch\u1ee9ng suy tim ph\u1ea3i?<\/p>\n

C\u00e2u 11 : M\u00f4 t\u1ea3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng c\u1ee7a b\u1ed9 m\u00e1y h\u00f4 h\u1ea5p ?<\/p>\n

C\u00e2u 12: M\u00f4 t\u1ea3 c\u00e1ch kh\u00e1m h\u00f4 h\u1ea5p b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p nh\u00ecn v\u00e0 s\u1edd<\/p>\n

C\u00e2u 13: M\u00f4 t\u1ea3 c\u00e1ch kh\u00e1m h\u00f4 h\u1ea5p b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p g\u00f5 v\u00e0 nghe<\/p>\n

C\u00e2u 14: Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i ?<\/p>\n

C\u00e2u 15: V\u1ecb tr\u00ed ch\u1ecdc d\u00f2 m\u00e0ng ph\u1ed5i v\u00e0 XQ ph\u1ed5i th\u1eb3ng:<\/p>\n

C\u00e2u 16:Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a, nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i<\/p>\n

C\u00e2u 17: tr\u00ecnh b\u00e0y kh\u00e1m v\u1eadn \u0111\u1ed9ng<\/p>\n

C\u00e2u 18:. tr\u00ecnh b\u00e0y kh\u00e1m ph\u1ea3n x\u1ea1?<\/p>\n

C\u00e2u 19: tr\u00ecnh b\u00e0y Kh\u00e1m c\u1ea3m gi\u00e1c?<\/p>\n

C\u00e2u 20: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m tr\u01b0\u01a1ng l\u1ef1c c\u01a1 ? Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m c\u01a1 l\u1ef1c ?<\/p>\n

C\u00e2u 21 :tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m d\u1ea5u hi\u1ec7u Barr\u00e9 v\u00e0 c\u00e1c b\u1eadc c\u01a1 l\u1ef1c?<\/p>\n

C\u00e2u 22: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m d\u1ea5u hi\u1ec7u Hoffmann v\u00e0 d\u1ea5u hi\u1ec7u Babinski.<\/p>\n

C\u00e2u 23: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m ph\u1ea3n x\u1ea1 da v\u00e0 ni\u00eam m\u1ea1c ?<\/p>\n

C\u00e2u 24 : Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m 12 \u0111\u00f4i d\u00e2y th\u1ea7n kinh s\u1ecd ?<\/p>\n

C\u00e2u 25: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m l\u00e2m s\u00e0ng kh\u1edbp ?<\/p>\n

C\u00e2u 26: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m m\u1ed9t s\u1ed1 kh\u1edbp th\u01b0\u1eddng g\u1eb7p: kh\u1edbp h\u00e1ng , kh\u1edbp g\u1ed1i , kh\u1edbp vai ?<\/p>\n

C\u00e2u 27: C\u00e1ch ph\u00e2n khu v\u00f9ng b\u1ee5ng(c\u00f3 h\u00ecnh v\u1ebd)? H\u00ecnh chi\u1ebfu c\u1ee7a c\u00e1c t\u1ea1ng l\u00ean t\u1eebng v\u00f9ng?<\/p>\n

C\u00e2u 28: Tr\u00ecnh b\u00e0y kh\u00e1m b\u1ee5ng b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p nh\u00ecn? Nh\u1eefng thay \u0111\u1ed5i b\u1ec7nh l\u00fd?<\/p>\n

C\u00e2u 29: Tr\u00ecnh b\u00e0y c\u00e1ch h\u1ecfi 1 b\u1ec7nh nh\u00e2n b\u1ecb \u0111au b\u1ee5ng?<\/p>\n

C\u00e2u 30 : C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y \u0111au b\u1ee5ng \u1edf n\u1eeda v\u00f9ng b\u1ee5ng tr\u00ean v\u00e0 th\u01b0\u1ee3ng v\u1ecb?v\u00f9ng h\u1ed1 ch\u1eadu v\u00e0 n\u1eeda b\u1ee5ng d\u01b0\u1edbi ?<\/p>\n

C\u00e2u 31: Tr\u00ecnh b\u00e0y th\u0103m kh\u00e1m 1 ng\u01b0\u1eddi b\u1ec7nh gan to?<\/p>\n

C\u00e2u 32: tr\u00ecnh b\u00e0y chu\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi gan to?<\/p>\n

C\u00e2u 33: tr\u00ecnh b\u00e0y c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y gan to?<\/p>\n

C\u00e2u 34: Th\u0103m kh\u00e1m v\u00e0 ch\u1ea9n \u0111o\u00e1n c\u1ed3 ch\u01b0\u1edbng?<\/p>\n

C\u00e2u 35: c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y c\u1ed5 ch\u01b0\u1edbng?<\/p>\n

C\u00e2u 36: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a v\u00e0 c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y thi\u1ebfu m\u00e1u ?<\/p>\n

C\u00e2u 37: Tr\u00ecnh b\u00e0y c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 ph\u00e2n \u0111\u1ed9 thi\u1ebfu m\u00e1u c\u1ea5p ?<\/p>\n

C\u00e2u 38:ph\u00e2n bi\u1ec7t thi\u1ebfu m\u00e1u c\u1ea5p v\u00e0 thi\u1ebfu m\u00e1u m\u1ea1n?<\/p>\n

C\u00e2u 39: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a v\u00e0 c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y xu\u1ea5t huy\u1ebft?<\/p>\n

C\u00e2u 40: Tr\u00ecnh b\u00e0y c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng c\u1ee7a xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da ?<\/p>\n

C\u00e2u 41: Tr\u00ecnh b\u00e0y c\u00e1c b\u01b0\u1edbc th\u0103m kh\u00e1m th\u1ef1c th\u1ec3 th\u1eadn ?<\/p>\n

C\u00e2u 42 : V\u1ecb tr\u00ed v\u00e0 c\u00e1ch th\u0103m kh\u00e1m c\u00e1c \u0111i\u1ec3m \u0111au ni\u1ec7u qu\u1ea3n v\u00e0 c\u00e1c \u0111i\u1ec3m \u0111au c\u1ee7a th\u1eadn ?<\/p>\n

C\u00e2u 43:Tr\u00ecnh b\u00e0y c\u00e1c ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t th\u1eadn to?<\/p>\n

C\u00e2u 44: Tr\u00ecnh b\u00e0y c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh \u0111\u00e1i m\u00e1u?<\/p>\n

C\u00e2u 45: Nguy\u00ean nh\u00e2n \u0111\u00e1i m\u00e1u th\u01b0\u1eddng g\u1eb7p?<\/p>\n

C\u00e2u 46: Tr\u00ecnh b\u00e0y c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y ph\u00f9 to\u00e0n th\u00e2n ?<\/p>\n

C\u00e2u 47: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a v\u00e0 c\u00e1c b\u01b0\u1edbc th\u0103m kh\u00e1m ph\u00f9<\/p>\n

C\u00e2u 48: N\u00eau ch\u1ea9n \u0111o\u00e1n ph\u00f9 v\u00e0 c\u00e1c c\u1eadn l\u00e2m sang c\u1ea7n thi\u1ebft trong ch\u1ea9n \u0111o\u00e1n ph\u00f9<\/p>\n

C\u00e2u 49: C\u00e1ch kh\u00e1m LS tuy\u1ebfn gi\u00e1p Ph\u00e2n \u0111\u1ed9 b\u01b0\u1edbu gi\u00e1p theo t\u1ed5 ch\u1ee9c y t\u1ebf th\u1ebf gi\u1edbi (WHO)?<\/p>\n

C\u00e2u 50 : Tr\u00ecnh b\u00e0y nguy\u00ean nh\u00e2n, tr.ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 CLS c\u1ee7a h\u1ed9i ch\u1ee9ng c\u01b0\u1eddng gi\u00e1p ?<\/p>\n

C\u00e2u 51: C\u00e1ch kh\u00e1m LS to\u00e0n th\u00e2n:c\u00e2n n\u1eb7ng chi\u1ec1u cao,da l\u00f4ng t\u00f3c trong kh\u00e1m b\u1ec7nh h\u1ec7 n\u1ed9i ti\u1ebft ?<\/p>\n

C\u00e2u 52: C\u00e1ch kh\u00e1m c\u00e1c b\u1ed9 ph\u1eadn: tuy\u1ebfn gi\u00e1p,T.ho\u00e0n, T. h\u00f3a v\u00e0 ghi nh\u1eadn 1 s\u1ed1 t.ch b\u1ec7nh l\u00fd trg th\u0103m kh\u00e1m b\u1ec7nh h\u1ec7 n\u1ed9i ti\u1ebft.<\/p>\n

C\u00e2u 53:Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng suy gi\u00e1p<\/p>\n

C\u00e2u 54: ph\u00e2n lo\u1ea1i v\u00e0ng da?<\/p>\n

C\u00e2u 55: tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng?<\/p>\n

C\u00e2u 56: Tr\u00ecnh b\u00e0y c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y h\u00f4n m\u00ea v\u00e0 ph\u00e2n \u0111\u1ed9 h\u00f4n m\u00ea theo thang \u0111i\u1ec3m Glasgow.<\/p>\n

C\u00e2u 57:tr\u00ecnh b\u00e0y c\u00e1ch ph\u00e2n lo\u1ea1i h\u00f4n m\u00ea<\/p>\n

C\u00e2u 58.Tr\u00ecnh b\u00e0y \u0111\u01b0\u1ee3c c\u00e1c nguy\u00ean nh\u00e2n th\u1eadn to.<\/p>\n

C\u00e2u 1 : Tr\u00ecnh b\u00e0y c\u01a1 ch\u1ebf v\u00e0 ph\u00e2n \u0111\u1ed9 ti\u1ebfng th\u1ed5i \u1edf tim . Ph\u00e2n bi\u1ec7t ti\u1ebfng th\u1ed5i c\u01a1 n\u0103ng v\u00e0 th\u1ef1c th\u1ec3 khi nghe tim ?<\/p>\n

I. C\u01a1 ch\u1ebf ti\u1ebfng th\u1ed5i:<\/p>\n

Ti\u1ebfng th\u1ed5i xu\u1ea5t hi\u1ec7n khi c\u00f3 d\u00f2ng m\u00e1u xo\u00e1y m\u1ea1nh v\u00e0 th\u1eddi gian di chuy\u1ec3n c\u00f3 xo\u00e1y m\u1ea1nh k\u00e9o d\u00e0i tr\u00ean 0,15s. C\u01b0\u1eddng \u0111\u1ed9 v\u00e0 t\u1ea7n s\u1ed1 c\u1ee7a ti\u1ebfng th\u1ed5i li\u00ean quan \u0111\u1ebfn t\u1ed1c \u0111\u1ed9 v\u00e0 \u0111\u1ed9 ch\u00eanh \u00e1p c\u1ee7a d\u00f2ng m\u00e1u gi\u1eefa v\u1ecb tr\u00ed tr\u01b0\u1edbc v\u00e0 sau khi c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng xo\u00e1y m\u1ea1nh.<\/p>\n

* C\u01a1 ch\u1ebf :<\/p>\n

1. T\u0103ng t\u1ed1c \u0111\u1ed9 d\u00f2ng m\u00e1u<\/p>\n

2. D\u00f2ng m\u00e1u \u0111i t\u1eeb : Ch\u1ed7 r\u1ed9ng \u00e0 h\u1eb9p<\/p>\n

Ch\u1ed7 h\u1eb9p \u00e0 r\u1ed9ng<\/p>\n

3. Th\u00f4ng 2 bu\u1ed3ng tim ho\u1eb7c th\u00f4ng 2 m\u1ea1ch m\u00e1u v\u1edbi nhau<\/p>\n

4. \u0110\u1ed9 nh\u1edbt m\u00e1u gi\u1ea3m<\/p>\n

* Ph\u00e2n Lo\u1ea1i:<\/p>\n

\u2013 Ti\u1ebfng th\u1ed5i lo\u1ea1i t\u1ed1ng m\u00e1u (ti\u1ebfng th\u1ed5i ph\u1ee5t \u0111i):<\/p>\n

+thu\u1ed9c lo\u1ea1i t\u00e2m thu<\/p>\n

+vd:h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/p>\n

\u2013 Ti\u1ebfng th\u1ed5i tr\u00e0o ng\u01b0\u1ee3c (ti\u1ebfng th\u1ed5i ph\u1ee5t l\u1ea1i)<\/p>\n

+ t\u00e2m thu nh\u01b0 trong h\u1edf vale 2 l\u00e1<\/p>\n

+ t\u00e2m tr\u01b0\u01a1ng nh\u01b0 trong h\u1edf vale \u0110MC, \u0110MP.<\/p>\n

\u2013 Ti\u1ebfng th\u1ed5i ngo\u00e0i tim: ti\u1ebfng th\u1ed5i ngo\u00e0i hai c\u01a1 ch\u1ebf tr\u00ean.<\/p>\n

\u00d8 Th\u1ed5i t\u00e2m thu<\/p>\n

+ Th\u1ed5i t\u00e2m thu lo\u1ea1i t\u1ed1ng m\u00e1u:<\/p>\n

\u00b7 T\u1ea1o ra b\u1edfi d\u00f2ng m\u00e1u \u0111\u01b0\u1ee3c t\u1ed1ng ra \u0111\u01b0a v\u00e0o \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/p>\n

\u00b7 Xu\u1ea5t hi\u1ec7n khi: c\u00f3 v\u1eadt c\u1ea3n tr\u00ean \u0111\u01b0\u1eddng m\u00e1u ph\u1ee5t t\u1eeb th\u1ea5t ra \u0111\u1ed9ng m\u1ea1ch (VD: h\u1eb9p vale \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i) ho\u1eb7c do l\u01b0\u1ee3ng m\u00e1u ho\u1eb7c t\u1ed1c \u0111\u1ed9 d\u00f2ng m\u00e1u \u0111\u00e3 t\u0103ng l\u00ean \u0111i qua l\u1ed7 vale t\u1ed5 chim ch\u1ee7 ho\u1eb7c ph\u1ed5i (c\u01b0\u1eddng gi\u00e1p, thi\u1ebfu m\u00e1u, h\u1edf vale \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 kh\u00f4ng c\u00f3 h\u1eb9p)<\/p>\n

+ Th\u1ed5i to\u00e0n t\u00e2m thu do m\u00e1u tr\u00e0o ng\u01b0\u1ee3c:<\/p>\n

\u00b7 D\u00f2ng m\u00e1u b\u1ecb ph\u1ee5t ng\u01b0\u1ee3c tr\u1edf l\u1ea1i bu\u1ed3ng tim t\u1eeb \u0111\u00f3 n\u00f3 ph\u00e1t xu\u1ea5t<\/p>\n

\u00b7 Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0: h\u1edf vale 2 l\u00e1, 3 l\u00e1, th\u00f4ng li\u00ean th\u1ea5t.<\/p>\n

\u00b7 M\u00e1u ph\u1ee5t ng\u01b0\u1ee3c l\u1ea1i do ch\u00eanh l\u1ec7ch \u00e1p l\u1ef1c gi\u1eefa 2 bu\u1ed3ng tim,ngay sau khi xu\u1ea5t hi\u1ec7n T1,\u0111\u1ed9 ch\u00eanh l\u1ec7ch \u00e1p l\u1ef1c t\u1ed3n t\u1ea1i cho t\u1edbi khi m\u1edf vale nh\u0129 th\u1ea5t, ti\u1ebfng th\u1ed5i c\u00f3 th\u1ec3 k\u00e9o d\u00e0i qu\u00e1 T2<\/p>\n

II. Ph\u00e2n \u0111\u1ed9 ti\u1ebfng th\u1ed5i :<\/p>\n

+ \u0110\u1ed9 1\/6: Ch\u00fa \u00fd m\u1edbi nghe \u0111\u01b0\u1ee3c<\/p>\n

+ \u0110\u1ed9 2\/6: Nghe th\u1ea5y ngay nh\u01b0ng c\u01b0\u1eddng \u0111\u1ed9 nh\u1eb9<\/p>\n

+ \u0110\u1ed9 3\/6: Nghe r\u00f5 , Rung miu (-)<\/p>\n

+ \u0110\u1ed9 4\/6: M\u1ea1nh , Rung miu (+)<\/p>\n

+ \u0110\u1ed9 5\/6: R\u1ea5t m\u1ea1nh , Rung miu (+) , v\u1eabn nghe \u0111\u01b0\u1ee3c khi nghi\u00eang loa \u1ed1ng nghe<\/p>\n

+ \u0110\u1ed9 6\/6: R\u1ea5t m\u1ea1nh , Rung miu (+) , v\u1eabn nghe khi \u0111\u1eb7t \u1ed1ng nghe c\u00e1ch th\u00e0nh ng\u1ef1c 1-2 mm<\/p>\n

III. Ph\u00e2n bi\u1ec7t ti\u1ebfng th\u1ed5i th\u1ef1c th\u1ec3 v\u00e0 ti\u1ebfng th\u1ed5i c\u01a1 n\u0103ng.<\/p>\n

\u0110\u1eb7c \u0111i\u1ec3m<\/p>\n

Ti\u1ebfng th\u1ed5i c\u01a1 n\u0103ng<\/p>\n

Ti\u1ebfng th\u1ed5i th\u1ef1c th\u1ec3<\/p>\n

V\u1ecb tr\u00ed<\/p>\n

Van 2 l\u00e1 , \u0110MC<\/p>\n

C\u00f3 \u1edf c\u1ea3 5 \u1ed5 van tim<\/p>\n

Th\u1eddi gian<\/p>\n

T\u00e2m thu<\/p>\n

T\u00e2m thu, t\u00e2m tr\u01b0\u01a1ng, li\u00ean t\u1ee5c.<\/p>\n

C\u01b0\u1eddng \u0111\u1ed9<\/p>\n

< 3\/6 nh\u1eb9 , \u00eam d\u1ecbu 1\/6 \u00e06\/6 m\u1ea1nh r\u00f5 Rung miu ( – ) ( + ) H\u01b0\u1edbng lan Kh\u00f4ng Th\u01b0\u1eddng lan Th\u01b0\u1eddng xuy\u00ean Thay \u0111\u1ed5i th\u1eadm ch\u00ed m\u1ea5t \u0111i khi ng\u01b0\u1eddi b\u1ec7nh h\u00edt v\u00e0o s\u00e2u, \u0111\u1ed5i t\u01b0 th\u1ebf ho\u1eb7c sau k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. Th\u01b0\u1eddng xuy\u00ean khi thay \u0111\u1ed5i t\u01b0 th\u1ebf th\u00ec ti\u1ebfng th\u1ed5i kh\u00f4ng gi\u1ea3m. khi \u0111i\u1ec1u tr\u1ecb suy tim l\u00e0m cho bu\u1ed3ng tim nh\u1ecf l\u1ea1i th\u00ec ti\u1ebfng th\u1ed5i t\u00e2m thu s\u1ebd m\u1ea1nh h\u01a1n C\u00e2u 2 : Tr\u00ecnh b\u00e0y kh\u00e1m l\u00e2m s\u00e0ng m\u1ea1ch m\u00e1u trong th\u0103m kh\u00e1m h\u1ec7 tim m\u1ea1ch ? I. Kh\u00e1m \u0111\u1ed9ng m\u1ea1ch: 1. Nh\u00ecn : a. \u0110\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean x\u01a1 v\u1eefa : + \u0110M th\u00e1i d\u01b0\u01a1ng n\u1ed5i ngo\u1eb1n ngh\u00e8o + D\u1ea5u hi\u1ec7u gi\u1eadt d\u00e2y chu\u00f4ng b. Chi : + \u0110\u1ed9 l\u1edbn c\u1ee7a chi + M\u00e0u s\u1eafc c\u1ee7a chi : nh\u1ee3t , \u0111\u1ecf n\u00f3ng + U ho\u1eb7c ph\u1ed3ng m\u1ea1ch m\u00e1u :N\u1eb1m tr\u00ean \u0111\u01b0\u1eddng \u0111i c\u1ee7a \u0111\u1ed9ng m\u1ea1ch \u0110\u1eadp theo nh\u1ecbp m\u1ea1ch \u0111\u1eadp 2. S\u1edd : + Nhi\u1ec7t \u0111\u1ed9 da : l\u1ea1nh , n\u00f3ng + B\u1eaft m\u1ea1ch:T\u1ea7n s\u1ed1 , nh\u1ecbp \u0111i\u1ec7u , bi\u00ean\u0111\u1ed9 ?\u0110\u1ed9 \u0111\u00e0n h\u1ed3i, tr\u00f9ng v\u1edbi nh\u1ecbp tim ? M\u1ea1ch Corrigans : M\u1ea1ch n\u1ea3y m\u1ea1nh ch\u00ecm s\u00e2u v\u00e0 HAmax cao so v\u1edbi HAmin th\u1ea5p M\u1ea1ch ngh\u1ecbch: M\u1ea1ch y\u1ebfu \u0111i khi h\u00edt v\u00e0o, r\u00f5 h\u01a1n khi th\u1edf ra trong khi nh\u1ecbp tim v\u1eabn b\u00ecnh th\u01b0\u1eddng 3. Nghe : + Ti\u1ebfng th\u1ed5i t\u00e2m thu : H\u1eb9p , Ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch + Ti\u1ebfng th\u1ed5i li\u00ean t\u1ee5c : th\u00f4ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch , c\u00f2n \u1ed1ng \u0111\u1ed9ng m\u1ea1ch + Ti\u1ebfng th\u1ed5i k\u00e9p \u1edf \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i : g\u1eb7p trong h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng II. Kh\u00e1m t\u0129nh m\u1ea1ch : 1. Nh\u00ecn : + Ph\u00f9 , s\u01b0ng vi\u00eam ho\u1eb7c lo\u00e9t chi + T\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i c\u1ea7n ph\u00e2n bi\u1ec7t do sinh l\u00fd hay do b\u1ec7nh tim + Tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 : c\u1eeda \u2013 ch\u1ee7 , ch\u1ee7 – ch\u1ee7 , ch\u1ee7 – tr\u00ean + B\u00fai t\u0129nh m\u1ea1ch gi\u00e3n 2. S\u1edd : + Ph\u00f9 t\u0129nh m\u1ea1ch + B\u00fai t\u0129nh m\u1ea1ch gi\u00e3n + Rung miu v\u00f9ng th\u00f4ng \u0111\u1ed9ng t\u0129nh m\u1ea1ch + Nghi\u1ec7m ph\u00e1p ph\u00e1t hi\u1ec7n suy van t\u0129nh t\u0129nh m\u1ea1ch : Nghi\u1ec7m ph\u00e1p Schwartz : B\u00e0n tay \u0111\u1eb7t ph\u00eda d\u01b0\u1edbi chi ch\u1eb7n kh\u00f4ng cho m\u00e1u t\u0129nh m\u1ea1ch tr\u1edf v\u1ec1 tim B\u00e0n tay \u0111\u1eb7t ph\u00eda tr\u00ean \u00e9p m\u1ea1nh \u0111\u1ed9t ng\u1ed9t l\u00ean b\u00f3 t\u0129nh m\u1ea1ch gi\u00e3n : N\u1ebfu c\u00f3 t\u0129nh m\u1ea1ch gi\u00e3n , b\u00f3 t\u0129nh m\u1ea1ch gi\u00e3n c\u0103ng h\u01a1n ( d\u1ea5u hi\u1ec7u h\u1edf van t\u1ed5 chim c\u1ee7a t\u0129nh m\u1ea1ch ) Nghi\u1ec7m ph\u00e1p Trendelenburg : Bu\u1ed9c d\u00e2y th\u1eaft \u1edf c\u00e1c v\u1ecb tr\u00ed kh\u00e1c nhau c\u1ee7a chi d\u01b0\u1edbi \u1edf t\u01b0 th\u1ebf n\u1eb1m v\u00e0 \u0111\u1ea7u ti\u00ean \u1edf v\u1ecb tr\u00ed cao nh\u1ea5t ngh\u0129a l\u00e0 g\u1ed1c chi . sau \u0111\u00f3 \u0111\u1ec3 b\u1ec7nh nh\u00e2n \u0111\u1ee9ng d\u1eady v\u00e0 c\u1edfi d\u00e2y th\u1eaft: V\u1ecb tr\u00ed n\u00e0o c\u00f3 d\u00e2y th\u1eaft khi c\u1edfi ra th\u01b0\u1eddng \u1ee9ng v\u1edbi hi\u1ec7n t\u01b0\u1ee3ng \u0111\u1ea7y m\u00e1u t\u0129nh m\u1ea1ch ng\u01b0\u1ee3c d\u00f2ng l\u00e0 n\u01a1i t\u0129nh m\u1ea1ch n\u1ed1i th\u00f4ng gi\u1eefa m\u1ea1ch s\u00e2u v\u00e0 n\u00f4ng b\u1ecb gi\u00e3n + Nghi\u1ec7m ph\u00e1p ph\u00e1t hi\u1ec7n t\u1eafc t\u0129nh m\u1ea1ch : Th\u1eed nghi\u1ec7m Perthes: B\u1ec7nh nh\u00e2n \u0111\u1ee9ng v\u00e0 bu\u1ed9c garo t\u0129nh m\u1ea1ch n\u00f4ng d\u01b0\u1edbi kh\u1edbp g\u1ed1i ho\u1eb7c k\u1ec1 tr\u00ean kh\u1edbp g\u1ed1i. L\u00fac n\u00e0y, d\u00f2ng m\u00e1u t\u0129nh m\u1ea1ch s\u1ebd chuy\u1ec3n v\u1ec1 h\u1ec7 t\u0129nh m\u1ea1ch s\u00e2u. Cho b\u1ec7nh nh\u00e2n \u0111i b\u1ed9 nhanh t\u1ea1i ch\u1ed7, c\u00e1c c\u01a1 co b\u00f3p s\u1ebd \u0111\u1ea9y m\u00e1u t\u0129nh m\u1ea1ch s\u00e2u v\u1ec1 tim v\u00e0 d\u1ed3n m\u00e1u t\u1eeb h\u1ec7 t\u0129nh m\u1ea1ch n\u00f4ng v\u1ec1 t\u0129nh m\u1ea1ch s\u00e2u. N\u1ebfu con \u0111\u01b0\u1eddng n\u00e0y b\u1ecb ngh\u1ebdn t\u1eafc th\u00ec t\u0129nh m\u1ea1ch n\u00f4ng c\u0103ng ph\u1ed3ng, d\u01b0\u1edbi ch\u1ed7 th\u1eaft garo t\u00edm t\u00e1i v\u00e0 \u0111au. Th\u1eed nghi\u1ec7m Linton: B\u1ec7nh nh\u00e2n \u0111\u1ee9ng, garo t\u0129nh m\u1ea1ch n\u00f4ng \u1edf tr\u00ean g\u1ed1i, theo d\u00f5i t\u0129nh m\u1ea1ch n\u00f4ng \u1edf c\u1eb3ng ch\u00e2n. N\u1ebfu h\u1ec7 t\u0129nh m\u1ea1ch n\u00f4ng kh\u00f4ng c\u0103ng ph\u1ed3ng th\u00ec ch\u1ee9ng t\u1ecf m\u00e1u \u0111\u01b0\u1ee3c l\u01b0u chuy\u1ec3n v\u1ec1 h\u1ec7 t\u0129nh m\u1ea1ch s\u00e2u, n\u1ebfu h\u1ec7 t\u0129nh m\u1ea1ch n\u00f4ng c\u0103ng ph\u1ed3ng t\u1ee9c l\u00e0 c\u00f3 t\u1eafc ngh\u1ebdn h\u1ec7 t\u0129nh m\u1ea1ch s\u00e2u ho\u1eb7c m\u1ea5t l\u01b0u th\u00f4ng gi\u1eefa h\u1ec7 t\u0129nh m\u1ea1ch n\u00f4ng v\u00e0 s\u00e2u. C\u00e2u 3: nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng, ch\u1ea9n \u0111o\u00e1n suy tim I. Suy tim tr\u00e1i 1. Nguy\u00ean nh\u00e2n v T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch: L\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t g\u00e2y ra suy tim tr\u00e1i. Ch\u00ednh t\u0103ng huy\u1ebft \u00e1p \u0111\u00e3 l\u00e0m c\u1ea3n tr\u1edf s\u1ef1 t\u1ed1ng m\u00e1u c\u1ee7a th\u1ea5t tr\u00e1i t\u1ee9c l\u00e0 l\u00e0m t\u0103ng h\u1eadu g\u00e1nh. v M\u1ed9t s\u1ed1 b\u1ec7nh van tim: – H\u1edf h\u1eb9p \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u01a1n thu\u1ea7n ho\u1eb7c ph\u1ed1i h\u1ee3p v\u1edbi nhau – H\u1edf van 2 l\u00e1 v C\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim – Nh\u1ed3i m\u00e1u c\u01a1 tim – Vi\u00eam c\u01a1 tim do th\u1ea5p tim, nhi\u1ec5m \u0111\u1ed9c hay nhi\u1ec5m khu\u1ea9n – C\u00e1c b\u1ec7nh c\u01a1 tim v M\u1ed9t s\u1ed1 r\u1ed1i lo\u1ea1n nh\u1ecbp tim:c\u00f3 3 r\u1ed1i lo\u1ea1n nh\u1ecbp tim ch\u1ee7 y\u1ebfu c\u00f3 th\u1ec3 \u0111\u01b0a \u0111\u1ebfn b\u1ec7nh c\u1ea3nh c\u1ee7a ST tr\u00e1i: – C\u01a1n nh\u1ecbp nhanh k\u1ecbch ph\u00e1t tr\u00ean th\u1ea5t, nh\u1ea5t l\u00e0 c\u01a1n rung nh\u0129 hay cu\u1ed3ng \u0111\u1ed9ng nh\u0129 – C\u01a1n nh\u1ecbp nhanh th\u1ea5t – Block nh\u0129 th\u1ea5t ho\u00e0n to\u00e0n v M\u1ed9t s\u1ed1 b\u1ec7nh tim b\u1ea9m sinh – H\u1eb9p eo \u0110M ch\u1ec9 – C\u00f2n \u1ed1ng \u0111\u1ed9ng m\u1ea1ch – \u1ed0ng nh\u0129 th\u1ea5t chung 1.Tri\u1ec7u ch\u1ee9ng suy tim tr\u00e1i: a.Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng: + Kh\u00f3 th\u1edf: L\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. L\u00fac \u0111\u1ea7u ch\u1ec9 kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c. V\u1ec1 sau kh\u00f3 th\u1edf x\u1ea9y ra th\u01b0\u1eddng xuy\u00ean, b\u1ec7nh nh\u00e2n n\u1eb1m c\u0169ng kh\u00f3 th\u1edf, n\u00ean th\u01b0\u1eddng ph\u1ea3i ng\u1ed3i d\u1eady \u0111\u1ec3 th\u1edf. Di\u1ec5n bi\u1ebfn v\u00e0 m\u1ee9c \u0111\u1ed9 kh\u00f3 th\u1edf c\u0169ng r\u1ea5t kh\u00e1c nhau: C\u00f3 khi \u0111\u1ebfn m\u1ed9t c\u00e1ch d\u1ea7n d\u1ea7n, nh\u01b0ng nhi\u1ec1u khi kh\u00f3 th\u1edf l\u1ea1i \u1eadp \u0111\u1ebfn m\u1ed9t c\u00e1ch \u0111\u1ed9t ng\u1ed9t, kh\u00f3 th\u1edf d\u1eef d\u1ed9i nh\u01b0 trong c\u01a1n hen tim, ph\u00f9 ph\u1ed5i c\u1ea5p. + Ho: hay x\u1ea3y ra v\u00e0o ban \u0111\u00eam ho\u1eb7c khi b\u1ec7nh nh\u00e2n g\u1eafng s\u1ee9c. Th\u01b0\u1eddng l\u00e0 ho khan, nh\u01b0ng c\u0169ng c\u00f3 khi ho ra \u0111\u1eddm l\u1eabn v\u1edbi m\u1ed9t \u00edt m\u00e1u t\u01b0\u01a1i. b.Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3: – Kh\u00e1m tim: Nh\u00ecn v\u00e0 s\u1edd th\u1ea5y m\u1ecfm tim \u0111\u1eadp h\u01a1i l\u1ec7ch sang tr\u00e1i. Nghe tim: ngo\u00e0i tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 g\u1eb7p c\u1ee7a m\u1ed9t b\u1ec7nh van tim g\u00e2y n\u00ean suy tim tr\u00e1i, ta th\u01b0\u1eddng th\u1ea5y 3 d\u1ea5u hi\u1ec7u: + Nh\u1ecbp tim nhanh. + C\u00f3 th\u1ec3 th\u1ea5y ti\u1ebfng ng\u1ef1a phi. + C\u0169ng th\u01b0\u1eddng th\u1ea5y c\u00f3 m\u1ed9t ti\u1ebfng th\u1ed5i t\u00e2m thu nh\u1eb9 \u1edf m\u1ecfm, d\u1ea5u hi\u1ec7u c\u1ee7a h\u1edf hai l\u00e1 c\u01a1 n\u0103ng v\u00ec bu\u1ed3ng th\u1ea5t tr\u00e1i gi\u00e3n to. – Kh\u00e1m ph\u1ed5i:Th\u01b0\u1eddng th\u1ea5y c\u00f3 m\u1ed9t s\u1ed1 ran \u1ea9m \u1edf hai \u0111\u00e1y ph\u1ed5i. Trong tr\u01b0\u1eddng h\u1ee3p c\u01a1n hen tim ta c\u00f3 th\u1ec3 nghe \u0111\u01b0\u1ee3c nhi\u1ec1u ran r\u00edt ran \u1ea9m \u1edf ph\u1ed5i, c\u00f2n trong tr\u01b0\u1eddng h\u1ee3p ph\u00f9 ph\u1ed5i c\u1ea5p ta s\u1ebd nghe th\u1ea5y r\u1ea5t nhi\u1ec1u ran \u1ea9m nh\u1ecf h\u1ea1t t\u1eeb hai \u0111\u00e1y ph\u1ed5i d\u00e2ng nhanh l\u00ean kh\u1eafp hai ph\u1ebf tr\u01b0\u1eddng nh\u01b0 \u201cth\u1ee7y tri\u1ec1u d\u00e2ng\u201d. – Huy\u1ebft \u00e1p: trong \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p, huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch t\u1ed1i \u0111a th\u01b0\u1eddng b\u1ecb gi\u1ea3m xu\u1ed1ng, huy\u1ebft \u00e1p t\u1ed1i thi\u1ec3u b\u00ecnh th\u01b0\u1eddng n\u00ean s\u1ed1 huy\u1ebft \u00e1p ch\u00eanh l\u1ec7ch th\u01b0\u1eddng b\u1ecb nh\u1ecf l\u1ea1i. c.C\u1eadn l\u00e2m s\u00e0ng: – Xquang: + Tim to ra, nh\u1ea5t l\u00e0 c\u00e1c bu\u1ed3ng tim b\u00ean tr\u00e1i. Tr\u00ean phim th\u1eb3ng: T\u00e2m th\u1ea5t tr\u00e1i gi\u00e3n, bi\u1ec3u hi\u1ec7n b\u1eb1ng cung d\u01b0\u1edbi b\u00ean tr\u00e1i h\u01a1i ph\u1ed3ng v\u00e0 b\u1ecb k\u00e9o d\u00e0i ra. + C\u1ea3 hai ph\u1ed5i \u0111\u1ec1u m\u1edd, nh\u1ea5t l\u00e0 \u1edf v\u00f9ng r\u1ed1n ph\u1ed5i. \u0110\u00f4i khi c\u00f3 th\u1ec3 g\u1eb7p h\u00ecnh \u1ea3nh \u0111\u01b0\u1eddng Kerley (do ph\u00f9 c\u00e1c t\u1ed5 ch\u1ee9c k\u1ebb c\u1ee7a h\u1ec7 th\u1ed1ng b\u1ea1ch huy\u1ebft \u1edf ph\u1ed5i) \u0110i\u1ec7n t\u00e2m \u0111\u1ed3: + Th\u01b0\u1eddng ch\u1ec9 th\u1ea5y nh\u1eefng d\u1ea5u hi\u1ec7u th\u1ec3 hi\u1ec7n t\u0103ng g\u00e1nh c\u1ee7a c\u00e1c bu\u1ed3ng tim tr\u00e1i: + Tr\u1ee5c tr\u00e1i, d\u00e0y nh\u0129 tr\u00e1i v\u00e0 ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i. – Si\u00eau \u00e2m tim: th\u01b0\u1eddng th\u1ea5y k\u00edch th\u01b0\u1edbc c\u00e1c bu\u1ed3ng tim tr\u00e1i (nh\u0129 tr\u00e1i v\u00e0 nh\u1ea5t l\u00e0 th\u1ea5t tr\u00e1i) gi\u00e3n to. Ngo\u00e0i ra si\u00eau \u00e2m tim c\u00f2n gi\u00fap cho ch\u00fang ta bi\u1ebft \u0111\u01b0\u1ee3c s\u1ef1 co b\u00f3p c\u1ee7a c\u00e1c v\u00e1ch tim c\u0169ng nh\u01b0 \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c ch\u00ednh x\u00e1c ch\u1ee9c n\u0103ng c\u1ee7a t\u00e2m th\u1ea5t tr\u00e1i. Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, si\u00eau \u00e2m c\u00f2n gi\u00fap cho ta kh\u1eb3ng \u0111\u1ecbnh \u0111\u01b0\u1ee3c m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n \u0111\u00e3 g\u00e2y ra suy tim tr\u00e1i nh\u01b0: c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u1ee7a van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, b\u1ec7nh c\u01a1 tim. + Th\u0103m d\u00f2 huy\u1ebft \u0111\u1ed9ng: N\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n th\u00f4ng tim v\u00e0 ch\u1ee5p m\u1ea1ch \u2013 tim s\u1ebd cho ph\u00e9p ta: \u00d8 \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 suy tim tr\u00e1i th\u00f4ng qua vi\u1ec7c do ch\u1ec9 s\u1ed1 tim (b\u00ecnh th\u01b0\u1eddng: 3 \u2013 3,5 l\u1ea7n\/ph\u00fat\/m2), \u0111o \u00e1p l\u1ef1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng c\u1ee7a t\u00e2m th\u1ea5t tr\u00e1i. \u00d8 \u0110\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c m\u1ee9c \u0111\u1ed9 n\u1eb7ng nh\u1eb9 c\u1ee7a m\u1ed9t s\u1ed1 b\u1ec7nh van tim. II. Suy tim ph\u1ea3i 1. Nguy\u00ean nh\u00e2n – C\u00e1c nguy\u00ean nh\u00e2n v\u1ec1 ph\u1ed5i v\u00e0 d\u1ecb d\u1ea1ng l\u1ed3ng ng\u1ef1c, c\u1ed9t s\u1ed1ng. C\u00e1c nguy\u00ean nh\u00e2n v\u1ec1 c\u1ed9t s\u1ed1ng v\u00e0 d\u1ecb d\u1ea1ng l\u1ed3ng ng\u1ef1c kh\u00e1c – H\u1eb9p van 2 l\u00e1 l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf Vi\u1ec7t Nam – M\u1ed9t s\u1ed1 b\u1ec7nh tim b\u1ea9m sinh: h\u1eb9p \u0110M ph\u1ed5i tam ch\u1ee9ng Fallow. M\u1ed9t s\u1ed1 b\u1ec7nh tim kh\u00e1c c\u00f3 lu\u1ed3ng shunt tr\u00e1i- ph\u1ea3i (th\u00f4ng li\u00ean nh\u0129, th\u00f4ng li\u00ean th\u1ea5t…) \u0111\u1ebfn giai \u0111o\u1ea1n mu\u1ed9n s\u1ebd c\u00f3 bi\u1ebfn ch\u1ee9ng c\u1ee7a t\u0103ng \u00e1p \u0110M ph\u1ed5i v\u00e0 g\u00e2y suy tim tr\u00e1i – Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n g\u00e2y t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng \u1edf van 3 l\u00e1 – M\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n \u00edt g\u1eb7p: u nh\u1ea7y nh\u1ec9 tr\u00e1i, v\u1ee1 t\u00fai ph\u00ecnh xoang Valsalva v\u00e0o c\u00e1c bu\u1ed3ng tim ph\u1ea3i… 2.Tri\u1ec7u ch\u1ee9ng suy tim ph\u1ea3i: a.Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng: -Kh\u00f3 th\u1edf \u00edt ho\u1eb7c nhi\u1ec1u, nh\u01b0ng kh\u00f3 th\u1edf th\u01b0\u1eddng xuy\u00ean ng\u00e0y m\u1ed9t n\u1eb7ng d\u1ea7n v\u00e0 kh\u00f4ng c\u00f3 c\u00e1c c\u01a1n k\u1ecbch ph\u00e1t nh\u01b0 trong suy tim tr\u00e1i. -Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n hay c\u00f3 c\u1ea3m gi\u00e1c \u0111au t\u1ee9c \u1edf v\u00f9ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i (do gan to v\u00e0 \u0111au). b.Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3: -Gan to \u0111\u1ec1u, m\u1eb7t nh\u1eb5n, b\u1edd t\u00f9, \u0111au m\u1ed9t c\u00e1ch t\u1ef1 ph\u00e1t ho\u1eb7c khi s\u1edd v\u00e0o gan th\u00ec th\u1ea5y \u0111au. -L\u00fac \u0111\u1ea7u, gan nh\u1ecf \u0111i khi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u00e0 gan to l\u1ea1i trong \u0111\u1ee3t suy tim sau, n\u00ean c\u00f2n g\u1ecdi l\u00e0 gan \u201c\u0111\u00e0n x\u1ebfp\u201d. V\u1ec1 sau, do \u1ee9 m\u00e1u l\u00e2u, n\u00ean gan kh\u00f4ng thu nh\u1ecf \u0111\u01b0\u1ee3c n\u1eefa v\u00e0 tr\u1edf n\u00ean c\u1ee9ng. -T\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i to v\u00e0 d\u1ea5u hi\u1ec7u ph\u1ea3n h\u1ed3i gan t\u0129nh m\u1ea1ch c\u1ed5 (+). -\u00c1p l\u1ef1c t\u0129nh m\u1ea1ch trung \u01b0\u01a1ng v\u00e0 \u00e1o l\u1ef1c t\u0129nh m\u1ea1ch ngo\u1ea1i bi\u00ean \u0111\u1ec1u t\u0103ng cao. -T\u00edm da v\u00e0 ni\u00eam m\u1ea1c: T\u00edm l\u00e0 do m\u00e1u \u1ee9 tr\u1ec7 ngo\u1ea1i bi\u00ean, n\u00ean l\u01b0\u1ee3ng Hemoglobin kh\u1eed t\u0103ng l\u00ean \u1edf trong m\u00e1u. T\u00f9y theo m\u1ee9c \u0111\u1ed9 suy tim m\u00e0 t\u00edm nhi\u1ec1u hay \u00edt. N\u1ebfu suy tim nh\u1eb9 th\u00ec ch\u1ec9 th\u1ea5y t\u00edm \u00edt \u1edf m\u00f4i v\u00e0 \u0111\u1ea7u chi. C\u00f2n n\u1ebfu suy tim n\u1eb7ng th\u00ec c\u00f3 th\u1ec3 th\u1ea5y t\u00edm r\u00f5 \u1edf to\u00e0n th\u00e2n. -Ph\u00f9: ph\u00f9 m\u1ec1m, l\u00fac \u0111\u1ea7u ch\u1ec9 khu tr\u00fa \u1edf hai chi d\u01b0\u1edbi, v\u1ec1 sau n\u1ebfu suy tim n\u1eb7ng th\u00ec c\u00f3 th\u1ec3 ph\u00f9 to\u00e0n th\u00e2n. Th\u1eadm ch\u00ed c\u00f3 th\u1ec3 c\u00f3 th\u00eam tr\u00e0n d\u1ecbch c\u00e1c m\u00e0ng (tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, c\u1ed5 ch\u01b0\u1edbng\u2026) -B\u1ec7nh nh\u00e2n th\u01b0\u1eddng \u0111\u00e1i \u00edt (kho\u1ea3ng 200 \u2013 500ml\/ng\u00e0y), n\u01b0\u1edbc ti\u1ec3u s\u1eabm m\u00e0u. -Kh\u00e1m tim: + S\u1edd: c\u00f3 th\u1ec3 th\u1ea5y d\u1ea5u hi\u1ec7u Hartzer (t\u00e2m th\u1ea5t ph\u1ea3i \u0111\u1eadp \u1edf v\u00f9ng m\u0169i \u1ee9c) nh\u01b0ng kh\u00f4ng ph\u1ea3i b\u1ec7nh nh\u00e2n n\u00e0o c\u0169ng c\u00f3 d\u1ea5u hi\u1ec7u n\u00e0y. + Nghe: Ngo\u00e0i c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh \u0111\u00e3 g\u00e2y suy tim ph\u1ea3i, ta c\u00f2n c\u00f3 th\u1ec3 nghe th\u1ea5y nh\u1ecbp tim th\u01b0\u1eddng nhanh, \u0111\u00f4i khi c\u00f3 th\u1ec3 nghe \u0111\u01b0\u1ee3c ti\u1ebfng ng\u1ef1a phi ph\u1ea3i. C\u0169ng c\u00f3 khi nghe th\u1ea5y m\u1ed9t ti\u1ebfng th\u1ed5i t\u00e2m thu nh\u1eb9 \u1edf trong m\u1ecfm \u1edf v\u00f9ng m\u0169i \u1ee9c do h\u1edf ba l\u00e1 c\u01a1 n\u0103ng. Khi h\u00edt v\u00e0o s\u00e2u th\u00ec ti\u1ebfng th\u1ed5i n\u00e0y th\u01b0\u1eddng r\u00f5 h\u01a1n. -Huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch t\u1ed1i \u0111a b\u00ecnh th\u01b0\u1eddng, nh\u01b0ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch t\u1ed1i thi\u1ec3u th\u01b0\u1eddng t\u0103ng l\u00ean. c.C\u1eadn l\u00e2m s\u00e0ng: -Tr\u1eeb tr\u01b0\u1eddng h\u1ee3p suy tim ph\u1ea3i do h\u1eb9p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m ri\u00eang c\u00f2n trong \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00e1c ta th\u1ea5y: Xquang: + Tr\u00ean phim tim ph\u1ed5i th\u1eb3ng: cung d\u01b0\u1edbi ph\u1ea3i (th\u1ec3 hi\u1ec7n t\u00e2m nh\u0129 ph\u1ea3i) gi\u00e3n, m\u1ecfm tim n\u00e2ng cao h\u01a1n ph\u00eda tr\u00ean c\u1ee7a v\u00f2m ho\u00e0nh tr\u00e1i do t\u00e2m th\u1ea5t ph\u1ea3i gi\u00e3n, \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u0169ng gi\u00e3n to, ph\u1ed5i m\u1edd nhi\u1ec1u do \u1ee9 m\u00e1u \u1edf ph\u1ed5i. + Tr\u00ean phim nghi\u00eang tr\u00e1i th\u1ea5t ph\u1ea3i to l\u00e0m cho kho\u1ea3ng s\u00e1ng sau x\u01b0\u01a1ng \u1ee9c b\u1ecb h\u1eb9p l\u1ea1i. \u0110i\u1ec7n t\u00e2m \u0111\u1ed3: th\u01b0\u1eddng th\u1ea5y c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a tr\u1ee5c ph\u1ea3i: d\u00e0y nh\u0129 ph\u1ea3i, d\u00e0y th\u1ea5t ph\u1ea3i. Si\u00eau \u00e2m: ch\u1ee7 y\u1ebfu th\u1ea5y k\u00edch th\u01b0\u1edbc th\u1ea5t ph\u1ea3i gi\u00e3n to. Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. Th\u0103m d\u00f2 huy\u1ebft \u0111\u1ed9ng: \u00c1p l\u1ef1c cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng c\u1ee7a t\u00e2m th\u1ea5t ph\u1ea3i t\u0103ng (> 12mmHg) \u00e1p l\u1ef1c \u0111\u1ed9ng ph\u1ed5i c\u0169ng t\u0103ng.<\/p>\n

III. Suy tim to\u00e0n b\u1ed9<\/p>\n

1. Nguy\u00ean nh\u00e2n<\/p>\n

– Th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p suy tim tr\u00e1i ti\u1ebfn tri\u1ec3n th\u00e0nh suy tim to\u00e0n b\u1ed9<\/p>\n

– C\u00e1c b\u1ec7nh c\u01a1 tim gi\u00e3n<\/p>\n

– Vi\u00eam to\u00e0n b\u1ed9 do th\u1ea5p tim, vi\u00eam c\u01a1 tim<\/p>\n

– Cu\u1ed1i c\u00f9ng c\u1ea7n ph\u1ea3i nh\u1eafc \u0111\u1ebfn m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n \u0111\u1eb7c bi\u1ec7t g\u00e2y suy tim to\u00e0n b\u1ed9 v\u1edbi l\u01b0u l\u01b0\u1ee3ng t\u0103ng: c\u01b0\u1eddng gi\u00e1p tr\u1ea1ng, thi\u1ebfu VTM B1, thi\u1ebfu m\u00e1u n\u1eb7ng, r\u00f2 \u0111\u1ed9ng-t\u0129nh m\u1ea1ch.<\/p>\n

2. Tri\u1ec7u ch\u1ee9ng suy tim to\u00e0n b\u1ed9:<\/p>\n

Th\u01b0\u1eddng l\u00e0 b\u1ec7nh c\u1ea3nh c\u1ee7a suy tim ph\u1ea3i \u1edf m\u1ee9c \u0111\u1ed9 n\u1eb7ng:<\/p>\n

-B\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf th\u01b0\u1eddng xuy\u00ean, ph\u00f9 to\u00e0n th\u00e2n.<\/p>\n

-T\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i to.<\/p>\n

-\u00c1p l\u1ef1c t\u0129nh m\u1ea1ch t\u0103ng r\u1ea5t cao.<\/p>\n

-Gan to nhi\u1ec1u.<\/p>\n

-Th\u01b0\u1eddng c\u00f3 th\u00eam tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, m\u00e0ng tim hay c\u1ed5 tr\u01b0\u1edbng.<\/p>\n

-Huy\u1ebft \u00e1p t\u1ed1i \u0111a h\u1ea1, huy\u1ebft \u00e1p t\u1ed1i thi\u1ec3u t\u0103ng l\u00e0m cho huy\u1ebft \u00e1p tr\u1edf n\u00ean b\u1ecb k\u1eb9t.<\/p>\n

+Xquang: tim to to\u00e0n b\u1ed9.<\/p>\n

+\u0110i\u1ec7n t\u00e2m \u0111\u1ed3: c\u00f3 th\u1ec3 c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a d\u00e0y hai th\u1ea5t.<\/p>\n

IV. CH\u1ea8N \u0110O\u00c1N SUY TIM<\/p>\n

1.Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/p>\n

a. Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:<\/p>\n

+ Kh\u00f3 th\u1edf: khi ngh\u1ec9 ng\u01a1i, khi g\u1eafng s\u1ee9c, khi n\u1eb1m, k\u1ecbch ph\u00e1t v\u1ec1 \u0111\u00eam<\/p>\n

+ M\u1ec7t, u\u1ec3 o\u1ea3i<\/p>\n

b. Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:<\/p>\n

+ Ph\u00f9 ngo\u1ea1i bi\u00ean, gan to, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i<\/p>\n

+ Ran \u1ea9m \u0111\u00e1y ph\u1ed5i<\/p>\n

+ Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i<\/p>\n

+ Th\u1edf nhanh n\u00f4ng, nh\u1ecbp tim nhanh<\/p>\n

c. Ch\u1ee9ng c\u1ee9 kh\u00e1ch quan b\u1ea5t th\u01b0\u1eddng v\u1ec1 c\u1ea5u tr\u00fac ho\u1eb7c ch\u1ee9c n\u0103ng c\u1ee7a tim l\u00fac ngh\u1ec9<\/p>\n

+ Tim to<\/p>\n

+ Ti\u1ebfng T3 \u1edf tim<\/p>\n

+ Ti\u1ebfng th\u1ed5i \u1edf tim<\/p>\n

+ Peptit b\u00e0i ni\u1ec7u t\u0103ng<\/p>\n

+ ECG b\u1ea5t th\u01b0\u1eddng<\/p>\n

+ Si\u00eau \u00e2m tim b\u1ea5t th\u01b0\u1eddng<\/p>\n

2.Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n:<\/p>\n

Nguy\u00ean nh\u00e2n hay g\u1eb7p:85-90%<\/p>\n

– B\u1ec7nh m\u1ea1ch v\u00e0nh<\/p>\n

– T\u0103ng huy\u1ebft \u00e1p<\/p>\n

– B\u1ec7nh van tim<\/p>\n

Nguy\u00ean nh\u00e2n hi\u1ebfm g\u1eb7p: 10-15%<\/p>\n

– B\u1ec7nh c\u01a1 tim<\/p>\n

– B\u1ec7nh m\u00e0ng ngo\u00e0i tim<\/p>\n

– B\u1ec7nh n\u1ed9i t\u00e2m m\u1ea1c<\/p>\n

– B\u1ec7nh tim b\u1ea9m sinh<\/p>\n

– R\u1ed1i lo\u1ea1n nh\u1ecbp tim k\u00e9o d\u00e0i<\/p>\n

– B\u1ec7nh ph\u1ed5i m\u00e3n t\u00ednh<\/p>\n

– Nguy\u00ean nh\u00e2n suy tim cung l\u01b0\u1ee3ng cao<\/p>\n

– Thu\u1ed1c v\u00e0 l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u<\/p>\n

3.Ch\u1ea9n \u0111o\u00e1n bi\u1ebfn ch\u1ee9ng:<\/p>\n

+ Ph\u00f9 ph\u1ed5i c\u1ea5p, hen tim, s\u1ed1c tim<\/p>\n

+ Nhi\u1ec5m tr\u00f9ng ph\u1ed5i<\/p>\n

+ R\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/p>\n

+ T\u1eafc m\u1ea1ch m\u00e1u<\/p>\n

+ X\u01a1 gan tim<\/p>\n

C\u00e2u 4 : Tr\u00ecnh b\u00e0y ph\u00e2n \u0111\u1ed9 h\u1ed9i ch\u1ee9ng suy tim theo NYHA , theo h\u1ed9i tim m\u1ea1ch Ch\u00e2u \u00c2u v\u00e0 theo l\u00e2m s\u00e0ng ?<\/p>\n

1. Ph\u00e2n \u0111\u1ed9 suy tim theo H\u1ed9i tim m\u1ea1ch New York (NYHA):<\/p>\n

\u0110\u1ed9<\/p>\n

Bi\u1ec3u hi\u1ec7n<\/p>\n

I<\/p>\n

+ C\u00f3 b\u1ec7nh tim nh\u01b0ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng n\u00e0o l\u00fac ngh\u1ec9 ng\u01a1i hay v\u1eadn \u0111\u1ed9ng th\u00f4ng th\u01b0\u1eddng h\u00e0ng ng\u00e0y<\/p>\n

+ Kh\u00f4ng h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng th\u1ec3 l\u1ef1c<\/p>\n

II<\/p>\n

+ B\u00ecnh th\u01b0\u1eddng l\u00fac ngh\u1ec9 ng\u01a1i , nh\u01b0ng khi v\u1eadn \u0111\u1ed9ng th\u00f4ng th\u01b0\u1eddng th\u00ec g\u00e2y tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng ( m\u1ec7t, kh\u00f3 th\u1edf, h\u1ed3i h\u1ed9p, \u0111au th\u1eaft ng\u1ef1c)<\/p>\n

+ H\u1ea1n ch\u1ebf nh\u1eb9 v\u1eadn \u0111\u1ed9ng th\u1ec3 l\u1ef1c<\/p>\n

III<\/p>\n

+ B\u00ecnh th\u01b0\u1eddng l\u00fac ngh\u1ec9 ng\u01a1i nh\u01b0ng khi v\u1eadn \u0111\u1ed9ng d\u01b0\u1edbi m\u1ee9c th\u00f4ng th\u1eeb\u01a1ng h\u00e0ng ng\u00e0y ( l\u00e0m vi\u1ec7c nh\u1eb9 h\u01a1n b\u00ecnh th\u01b0\u1eddng ) th\u00ec g\u00e2y tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng<\/p>\n

+ H\u1ea1n ch\u1ebf nhi\u1ec1u v\u1eadn \u0111\u1ed9ng th\u1ec3 l\u1ef1c<\/p>\n

IV<\/p>\n

+Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng c\u1ee7a suy tim xu\u1ea5t hi\u1ec7n th\u01b0\u1eddng xuy\u00ean, ngay c\u1ea3 khi BN ngh\u1ec9 ng\u01a1i; ch\u1ec9 c\u1ea7n m\u1ed9t v\u1eadn \u0111\u1ed9ng th\u1ec3 l\u1ef1c th\u00ec tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng gia t\u0103ng.<\/p>\n

+ Kh\u00f4ng v\u1eadn \u0111\u1ed9ng th\u1ec3 l\u1ef1c n\u00e0o m\u00e0 kh\u00f4ng g\u00e2y kh\u00f3 ch\u1ecbu cho BN<\/p>\n

2. Ph\u00e2n \u0111\u1ed9 suy tim theo h\u1ed9i tim m\u1ea1ch Ch\u00e2u \u00c2u (AHA):- Giai \u0111o\u1ea1n A: Nguy c\u01a1 cao suy tim nh\u01b0ng kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1ef1c th\u1ec3 tim , kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng suy tim<\/p>\n

– Giai \u0111o\u1ea1n B: C\u00f3 b\u1ec7nh tim th\u1ef1c th\u1ec3 nh\u01b0ngkh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng suy tim<\/p>\n

– Giai \u0111o\u1ea1n C: C\u00f3 b\u1ec7nh tim th\u1ef1c th\u1ec3 tr\u01b0\u1edbc \u0111\u00e2y ho\u1eb7c hi\u1ec7n t\u1ea1i c\u00f3 tri\u1ec7u ch\u1ee9ngsuy tim<\/p>\n

– Giai \u0111o\u1ea1n D: suy tim kh\u00e1ng tr\u1ecb, giai \u0111o\u1ea1n cu\u1ed1i c\u1ea7n can thi\u1ec7p \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c bi\u1ec7t<\/p>\n

3. Theo l\u00e2m s\u00e0ng<\/p>\n

D\u1ea5u hi\u1ec7u<\/p>\n

\u0110\u1ed9 I<\/p>\n

\u0110\u1ed9 II<\/p>\n

\u0110\u1ed9 III<\/p>\n

\u0110\u1ed9 IV<\/p>\n

Kh\u00f3 th\u1edf<\/p>\n

G\u1eafng s\u1ee9c nhi\u1ec1u<\/p>\n

G\u1eafng s\u1ee9c v\u1eeba<\/p>\n

G\u1eafng s\u1ee9c \u00edt<\/p>\n

Khi ngh\u1ec9 ng\u01a1i<\/p>\n

Ph\u00f9<\/p>\n

(-)<\/p>\n

Hai chi d\u01b0\u1edbi<\/p>\n

To\u00e0n th\u00e2n, \u0110a m\u00e0ng (+)<\/p>\n

To\u00e0n th\u00e2n,<\/p>\n

\u0110a m\u00e0ng (+ )<\/p>\n

Gan to<\/p>\n

(-)<\/p>\n

< 3cm PHGTMC (+) > 3cm<\/p>\n

PHGTMC (+)<\/p>\n

\u0110\u1ebfn r\u1ed1n<\/p>\n

PHGTMC (+)<\/p>\n

\u0110i\u1ec1u tr\u1ecb<\/p>\n

Nhanh kh\u1ecfi<\/p>\n

Kh\u1ecfi<\/p>\n

T\u00edch c\u1ef1c m\u1edbi kh\u1ecfi<\/p>\n

Kh\u00f4ng bao gi\u1edd kh\u1ecfi<\/p>\n

C\u00e2u 5: Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng c\u1ee7a b\u1ec7nh tim m\u1ea1ch<\/p>\n

-8 TCCN \u0111i\u1ec3n h\u00ecnh:\u0110au ng\u1ef1c,Kh\u00f3 th\u1edf,Ph\u00f9,Xanh t\u00edm,Ho-ho ra m\u00e1u,Ng\u1ea5t, \u0110\u00e1nh tr\u1ed1ng ng\u1ef1c, M\u1ec7t.<\/p>\n

I.\u0110au ng\u1ef1c<\/p>\n

v Nguy\u00ean nh\u00e2n:* C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ea7n khai th\u00e1c:<\/p>\n

+ Tim m\u1ea1ch:-V\u1ecb tr\u00ed<\/p>\n

– B\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh- h\u01b0\u1edbng lan<\/p>\n

– Vi\u00eam m\u00e0ng ngo\u00e0i tim- ki\u1ec3u \u0111au<\/p>\n

– B\u00f3c t\u00e1ch \u0111m ch\u1ee7- h\u00ecnh th\u1ee9c kh\u1edfi ph\u00e1t<\/p>\n

– T\u0103ng \u00e1p \u0111m ph\u1ed5i-nh\u1ed3i m\u00e1u ph\u1ed5i- c\u01b0\u1eddng \u0111\u1ed9<\/p>\n

– B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i- th\u1eddi gian k\u00e9o d\u00e0i<\/p>\n

+ph\u1ed5i:- y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t<\/p>\n

– TKMP, vi\u00eam m\u00e0ng ph\u1ed5i-y\u1ebfu t\u1ed1 gi\u1ea3m \u0111au<\/p>\n

– Ung th\u01b0 ph\u1ed5i- t\u1ea7n su\u1ea5t<\/p>\n

+ D\u1ea1 d\u00e0y \u2013ru\u1ed9t-tri\u1ec7u ch\u1ee9ng \u0111i k\u00e8m<\/p>\n

+ Th\u1ea7n kinh- c\u01a1 x\u01b0\u01a1ng kh\u1edbp<\/p>\n

+Kh\u00e1c: t\u00e2m l\u00fd, trung th\u1ea5t<\/p>\n

v C\u01a1n \u0111au th\u1eaft ng\u1ef1c \u0111i\u1ec3n h\u00ecnh:<\/p>\n

+ Nguy\u00ean nh\u00e2n: b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/p>\n

+ Th\u01b0\u1eddng g\u1eb7p tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 BMV<\/p>\n

+ Ho\u00e0n: x\u1ea3y ra \u0111\u1ed9t ng\u1ed9t, sau g\u1eafng s\u1ee9c, x\u00fac \u0111\u1ed9ng m\u1ea1nh<\/p>\n

+ C\u01b0\u1eddng: c\u1ea3m gi\u00e1c nh\u01b0 nghi\u1ec1n n\u00e1t, si\u1ebft ch\u1ea1t<\/p>\n

+ H\u01b0\u1edbng: lan l\u00ean h\u1ea7u h\u1ecdng, vai, h\u00e0m, m\u1eb7t trong c\u00e1nh tay tr\u00e1i, \u00edt khi lan xu\u1ed1ng r\u1ed1n v\u00e0 sau l\u01b0ng.<\/p>\n

+ T\u00ednh: t\u1eebng c\u01a1n<\/p>\n

+ V\u1ecb: \u0111au sau x\u01b0\u01a1ng \u1ee9c<\/p>\n

+ Chu: 20s-20p<\/p>\n

+ Gi\u1ea3m: khi ngh\u1ec9 ng\u01a1i or d\u00f9ng thu\u1ed1c gi\u00e3n m\u1ea1ch<\/p>\n

+ K\u00e8m: kh\u00f3 th\u1edf, m\u1ec7t, v\u00e3 m\u1ed3 h\u00f4i.<\/p>\n

v B\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/p>\n

+ L\u1edbp n\u1ed9i m\u1ea1c b\u1ecb r\u00e1ch ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch nu\u00f4i b\u1ecb v\u1ee1 trong l\u1edbp trung m\u1ea1c, l\u00e0m m\u00e1u t\u1ee5 d\u01b0\u1edbi l\u1edbp n\u1ed9i m\u1ea1c<\/p>\n

+ Nguy\u00ean nh\u00e2n: huy\u1ebft \u00e1p, ch\u1ea5n th\u01b0\u01a1ng, tho\u00e1i h\u00f3a<\/p>\n

+ \u0110\u1eb7c \u0111i\u1ec3m: – \u0111\u1ed9t ng\u1ed9t<\/p>\n

– \u0110au nh\u00f3i, \u0111au nh\u01b0 x\u00e9<\/p>\n

– D\u1eef d\u1ed9i v\u00e0 k\u00e9o d\u00e0i<\/p>\n

– V\u1ecb tr\u00ed: t\u00f9y thu\u1ed9c v\u00e0o n\u01a1i b\u00f3c t\u00e1ch v\u00e0 m\u1ee9c \u0111\u1ed9 lan r\u1ed9ng<\/p>\n

– C\u00f3 th\u1ec3 g\u00e2y t\u1eafc c\u00e1c nh\u00e1nh c\u1ee7a \u0111m ch\u1ee7<\/p>\n

II. Kh\u00f3 th\u1edf<\/p>\n

\u2013 L\u00e0 c\u1ea3m gi\u00e1c kh\u00f3 kh\u0103n, b\u1ecb tr\u1edf ng\u1ea1i trong khi h\u00edt th\u1edf.<\/p>\n

\u2013 C\u1ea7n ph\u00e2n bi\u1ec7t kh\u00f3 th\u1edf do tim v\u00e0 do c\u00e1c b\u1ec7nh l\u00fd v\u1ec1 ph\u1ed5i:<\/p>\n

+ Do tim: – g\u1eb7p trong: suy tim tr\u00e1i, h\u1eb9p van 2 l\u00e1<\/p>\n

-\u0111\u1eb7c \u0111i\u1ec3m: \u1ee9 huy\u1ebft \u1edf \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, mao m\u1ea1ch ph\u1ed5i<\/p>\n

Kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, ngh\u1ec9 ng\u01a1i, k\u1ecbch ph\u00e1t v\u1ec1 \u0111\u00eam<\/p>\n

+ Do b\u1ec7nh l\u00fd \u1edf ph\u1ed5i: – thuy\u00ean t\u1eafc ph\u1ed5i<\/p>\n

– t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean v\u00e0 d\u01b0\u1edbi (hen pq,vi\u00eam pq, CODP)<\/p>\n

– TKMP, TDMP, Tr\u00e0n kh\u00ed ph\u1ebf th\u0169ng<\/p>\n

III. Ph\u00f9<\/p>\n

\u2013 L\u00e0 t\u00ecnh tr\u1ea1ng \u1ee9 \u0111\u1ecdng d\u1ecbch trong kho\u1ea3ng gian b\u00e0o<\/p>\n

\u2013 C\u01a1 ch\u1ebf: + vai tr\u00f2 c\u1ee7a \u00e1p l\u1ef1c keo<\/p>\n

+ vai tr\u00f2 c\u1ee7a \u00e1p l\u1ef1c th\u1ee7y t\u0129nh<\/p>\n

+ t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch<\/p>\n

\u2013 Ph\u00e2n lo\u1ea1i:<\/p>\n

+ Ph\u00f9 to\u00e0n th\u1ec3 (ph\u00f9 m\u1ec1m \u0111\u1ed1i x\u1ee9ng): g\u1eb7p trong Suy tim ph\u1ea3i, suy t\u0129nh m\u1ea1ch s\u00e2u 2 ch\u00e2n , suy th\u1eadn m\u1ea1n, thu\u1ed1c gi\u1eef mu\u1ed1i n\u01b0\u1edbc…<\/p>\n

+ Ph\u00f9 khu tr\u00fa: g\u1eb7p trong- vi\u00eam\/t\u1eafc\/ch\u00e8n \u00e9p t\u0129nh m\u1ea1ch\/b\u1ea1ch m\u1ea1ch<\/p>\n

– T\u1eafc ngh\u1ebdn TMC tr\u00ean,<\/p>\n

– Nhi\u1ec5m tr\u00f9ng, h\u00f3a ch\u1ea5t, nhi\u1ec7t \u0111\u1ed9<\/p>\n

– Suy gi\u00e1p…<\/p>\n

IV. Xanh t\u00edm<\/p>\n

\u2013 L\u00e0 s\u1ef1 t\u00edm da, ni\u00eam m\u1ea1c, m\u00f3ng do l\u01b0\u1ee3ng Hb kh\u1eed >=5g\/dL ho\u1eb7c do s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a met-hemoglobin, suft-hemoglobin.<\/p>\n

\u2013 Ph\u00e2n lo\u1ea1i:<\/p>\n

\u00b7 T\u00edm TW: – \u0111\u1eb7c \u0111i\u1ec3m: xanh t\u00edm \u1edf da, ni\u00eam m\u1ea1c, \u0111\u1ea7u chi.<\/p>\n

-g\u1eb7p trong: th\u00f4ng li\u00ean nh\u0129, th\u00f4ng li\u00ean th\u1ea5t, c\u00f2n \u1ed1ng \u0111mach, t\u1ee9 ch\u1ee9ng Fallot.<\/p>\n

\u00b7 T\u00edm ngo\u1ea1i bi\u00ean: – \u0111\u1eb7c \u0111i\u1ec3m: xanh t\u00edm \u0111\u1ea7u chi<\/p>\n

-do cung l\u01b0\u1ee3ng tim th\u1ea5p, s\u1ed1c, r\u1ed1i lo\u1ea1n v\u1eadn m\u1ea1ch( Raynaud)<\/p>\n

V. Ho, ho ra m\u00e1u<\/p>\n

v Ho<\/p>\n

\u2013 L\u00e0 1 \u0111\u1ed9ng t\u00e1c nh\u1eb1m \u0111\u1ea9y m\u1ea1nh kh\u00ed, d\u1ecb v\u1eadt, ch\u1ea5t ti\u1ebft ra kh\u1ecfi \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p.<\/p>\n

\u2013 Nguy\u00ean nh\u00e2n: +b\u1ec7nh l\u00fd h\u00f4 h\u1ea5p<\/p>\n

+b\u1ec7nh l\u00fd tim m\u1ea1ch<\/p>\n

+tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y, th\u1ef1c qu\u1ea3n<\/p>\n

\u2013 Ho khan: kh\u00f4ng c\u00f3 \u0111\u1eddm, ho nhi\u1ec1u v\u1ec1 \u0111\u00eam, ho t\u0103ng khi g\u1eafng s\u1ee9c.<\/p>\n

v Ho ra m\u00e1u<\/p>\n

\u2013 Ph\u00e2n bi\u1ec7t v\u1edbi kh\u1ea1c ra m\u00e1u( t\u1eeb \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean)<\/p>\n

n\u00f4n ra m\u00e1u(\u0111\u01b0\u1eddng ti\u00eau h\u00f3a, c\u00f3 l\u1eabn th\u1ee9c \u0103n)<\/p>\n

B\u1ec7nh l\u00fd<\/p>\n

\u0110\u1eb7c \u0111i\u1ec3m ho<\/p>\n

Suy tim tr\u00e1i<\/p>\n

H\u1eb9p vale 2 l\u00e1<\/p>\n

Ban \u0111\u1ea7u ho khan, ho khi n\u1eb1m \u0111\u1ea7u th\u1ea5p, ho v\u1ec1 \u0111\u00eam sau \u0111\u00f3 ho ra m\u00e1u<\/p>\n

Ph\u00f9 ph\u1ed5i c\u1ea5p<\/p>\n

Ho kh\u1ea1c b\u1ecdt h\u1ed3ng, sau ho ra m\u00e1u t\u1eebng b\u00e3i<\/p>\n

Nh\u1ed3i m\u00e1u ph\u1ed5i<\/p>\n

Ho ra m\u00e1u ki\u1ec3u m\u00e0ng ph\u1ed5i, thg k\u00e8m TDMP<\/p>\n

Thuy\u00ean t\u1eafc ph\u1ed5i<\/p>\n

Huy\u1ebft kh\u1ed1i<\/p>\n

Ho ra m\u00e1u thg khi k\u1ebft h\u1ee3p v\u1edbi nh\u1ed3i m\u00e1u ph\u1ed5i<\/p>\n

H\u1eb9p vale 2 l\u00e1 kh\u00edt<\/p>\n

Ho ra m\u00e1u t\u01b0\u01a1i, l\u01b0\u1ee3ng nhi\u1ec1u t\u1eebng \u0111\u1ee3t<\/p>\n

VI. Ng\u1ea5t<\/p>\n

\u2013 L\u00e0 t\u00ecnh tr\u1ea1ng \u0111\u1ed9t ng\u1ed9t m\u1ea5t tri gi\u00e1c tho\u00e1ng qua do k\u00e9m t\u01b0\u1edbi m\u00e1u n\u00e3o v\u00e0 c\u00f3 h\u1ed3i ph\u1ee5c.<\/p>\n

\u2013 Nguy\u00ean nh\u00e2n:<\/p>\n

+ B\u1ec7nh l\u00fd th\u1ef1c th\u1ec3:<\/p>\n

\u00b7 H\u1eb9p van \u0111m ch\u1ee7, ph\u1ed5i<\/p>\n

\u00b7 U nh\u1ea7y nh\u0129 tr\u00e1i<\/p>\n

\u00b7 T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/p>\n

\u00b7 B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i t\u1eafc ngh\u1ebdn<\/p>\n

+ R\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/p>\n

+ Thu\u1ed1c<\/p>\n

VII. \u0110\u00e1nh tr\u1ed1ng ng\u1ef1c<\/p>\n

\u2013 L\u00e0 c\u1ea3m gi\u00e1c th\u1ea5y tim \u0111\u1eadp nhanh, m\u1ea1nh.<\/p>\n

\u2013 Nguy\u00ean nh\u00e2n:<\/p>\n

+ Nh\u1ecbp tim ch\u1eadm: bloc N-T, b\u1ec7nh l\u00fd n\u00fat xoang<\/p>\n

+ R\u1ed1i lo\u1ea1n nh\u1ecbp k\u1ecbch ph\u00e1t: nhanh nh\u0129, nhanh b\u1ed9 n\u1ed1i, cu\u1ed3ng nh\u0129, rung nh\u0129.<\/p>\n

+ Nhanh th\u1ea5t: \u0111au th\u1eaft ng\u1ef1c k\u00e8m ch\u00f3ng m\u1eb7t v\u00e0 ng\u1ea5t.<\/p>\n

VIII. M\u1ec7t<\/p>\n

\u2013 L\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a t\u00ecnh tr\u1ea1ng suy tim<\/p>\n

\u2013 Nguy\u00ean nh\u00e2n: do cung l\u01b0\u1ee3ng tim gi\u1ea3m th\u1ea5p<\/p>\n

D\u00f9ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb qu\u00e1 li\u1ec1u<\/p>\n

\u2013 M\u1ec7t \u0111\u1ed9t ng\u1ed9t d\u1eef d\u1ed9i c\u00f3 th\u1ec3 l\u00e0 TC \u0111i k\u00e8m Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p<\/p>\n

IX. Kh\u00e1c<\/p>\n

\u2013 Ti\u1ec3u \u0111\u00eam: TC s\u1edbm nh\u1ea5t trong suy tim \u1ee9 huy\u1ebft<\/p>\n

\u2013 Bi\u1ebfng \u0103n, \u0111\u1ea7y b\u1ee5ng, n\u1eb7ng t\u1ee9c h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, gi\u1ea3m c\u00e2n, suy ki\u1ec7t: suy tim ti\u1ebfn tri\u1ec3n<\/p>\n

\u2013 N\u00f4n, bu\u1ed3n n\u00f4n: ng\u1ed9 \u0111\u1ed9c Digoxin<\/p>\n

\u2013 Kh\u00e0n ti\u1ebfng: ph\u00ecnh \u0111mc, \u0111mp, Nh\u0129 tr\u00e1i l\u1edbn<\/p>\n

\u2013 S\u1ed1t k\u00e9o d\u00e0i: vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c k\u00e9o d\u00e0i<\/p>\n

C\u00e2u 6: C\u01a1 ch\u1ebf ti\u1ebfng T1, T2, T3 v\u00e0 T4 khi nghe ti\u1ebfng tim?<\/p>\n

\u00d8 T1: \u0110\u00f3ng van nh\u0129 th\u1ea5t,m\u1edf van t\u1ed5 chim, nghe r\u00f5 \u1edf m\u1ecfm tim. M\u1edf \u0111\u1ea7u t\u00e2m thu.<\/p>\n

\u00d8 T2: \u0111\u00f3ng van t\u1ed5 chim, nghe r\u00f5 \u1edf \u0111\u00e1y tim. M\u1edf \u0111\u1ea7u t\u00e2m tr\u01b0\u01a1ng.<\/p>\n

C\u00e1ch ti\u1ebfng T1 c\u1ee7a c\u00f9ng chu k\u1ef3 1 kho\u1ea3ng ngh\u1ec9 ng\u1eafn v\u00e0 T1 chu k\u1ef3 sau 1 kho\u1ea3ng ngh\u1ec9 d\u00e0i.<\/p>\n

\u00d8 T3 :<\/p>\n

\u2013 Sau ti\u1ebfng T2, \u0111\u1ea7u t\u00e2m tr\u01b0\u01a1ng trong th\u00ec v\u1ec1 \u0111\u1ea7y th\u1ea5t nhanh: Nh\u0129 t\u1ed1ng m\u00e1u \u0111\u1ed9t ng\u1ed9t xu\u1ed1ng th\u1ea5t (nh\u0129 kh\u00f4ng co b\u00f3p) l\u00e0m th\u1ea5t tr\u00e1i gi\u00e3n nhanh, m\u1ea1nh, ch\u1ea1m v\u00e0o th\u00e0nh ng\u1ef1c g\u00e2y n\u00ean ti\u1ebfng T3.<\/p>\n

\u2013 T3 sinh l\u00fd: g\u1eb7p \u1edf tr\u1ebb em, ng\u01b0\u1eddi <30 tu\u1ed5i \u2013 T3 b\u1ec7nh l\u00fd (ti\u1ebfng ng\u1ef1a phi): khi th\u00e0nh th\u1ea5t thi\u1ebfu \u1ed5n \u0111\u1ecbnh: gi\u00e3n(suy th\u1ea5t c\u1ea5p) hay do t\u0103ng l\u01b0\u1ee3ng m\u00e1u qua van Nh\u0129-th\u1ea5t. \u00d8 T4: \u2013 Cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng: nh\u0129 thu t\u1ed1ng n\u1ed1t l\u01b0\u1ee3ng m\u00e1u c\u00f2n l\u1ea1i xu\u1ed1ng th\u1ea5t l\u00e0m th\u1ea5t gi\u00e3n nhanh, \u0111\u1eadp v\u00e0o th\u00e0nh ng\u1ef1c g\u00e2y n\u00ean ti\u1ebfng T4 sinh l\u00fd. \u2013 Tr\u01b0\u1eddng h\u1ee3p suy tim, t\u1ed5n th\u01b0\u01a1ng l\u00e0m gi\u00e3n th\u00e0nh th\u1ea5t ( t\u0103ng huy\u1ebft \u00e1p, h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i) ta c\u0169ng nghe th\u1ea5y ti\u1ebfng ng\u1ef1a phi ti\u1ec1n t\u00e2m thu C\u00e2u 8: Tri\u1ec7u ch\u00fang l\u00e2m s\u00e0ng khi nghe tim h\u1eb9p van 2 l\u00e1 v\u00e0 h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7? 1.H\u1eb9p van 2 l\u00e1: + To\u00e0n th\u00e2n: \u00b7 N\u1ebfu m\u1eafc b\u1ec7nh tr\u01b0\u1edbc tu\u1ed5i d\u1eady th\u00ec: k\u00e9m ph\u00e1t tri\u1ec3n th\u1ec3 ch\u1ea5t \u00b7 N\u1ebfu x\u1ea3y ra sau tu\u1ed5i d\u1eady th\u00ec tr\u1ebb ph\u00e1t tri\u1ec3n g\u1ea7n nh\u01b0 b\u00ecnh th\u01b0\u1eddng. + C\u01a1 n\u0103ng: \u00b7 C\u00f3 khi ph\u00e1t hi\u1ec7n t\u00ecnh c\u1edd b\u1edfi kh\u00e1m s\u1ee9c kh\u1ecfe h\u00e0ng lo\u1ea1t m\u00e0 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng n\u00e0o ngay c\u1ea3 khi g\u1eafng s\u1ee9c. \u00b7 C\u00f3 khi b\u1ec7nh nh\u00e2n \u0111i kh\u00e1m v\u00ec kh\u00f3 th\u1edf, ho v\u00e0 kh\u1ea1c ra m\u00e1u, h\u1ed3i h\u1ed9p \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, nu\u1ed1t ngh\u1eb9n do t\u00e2m nh\u0129 ch\u00e8n \u00e9p v\u00e0o th\u1ef1c qu\u1ea3n nh\u1ea5t l\u00e0 khi g\u1eafng s\u1ee9c. + Th\u1ef1c th\u1ec3: \u00b7 Nghe tim l\u00e0 ch\u1ee7 y\u1ebfu, c\u00f3 th\u1ec3 nghe khi n\u1eb1m ng\u1eeda, n\u1eb1m nghi\u00eang tr\u00e1i ho\u1eb7c c\u00f3 khi ph\u1ea3i \u0111\u1ec3 b\u1ec7nh nh\u00e2n l\u00e0m \u0111\u1ed9ng t\u00e1c g\u1eafng s\u1ee9c. \u00b7 H\u1eb9p van hai l\u00e1 \u0111i\u1ec3n h\u00ecnh th\u01b0\u1eddng nghe \u0111\u01b0\u1ee3c c\u00e1c d\u1ea5u ch\u1ee9ng sau theo t\u1ea7n su\u1ea5t hay g\u1eb7p: – Ti\u1ebfng T1 \u0111anh \u1edf m\u1ecfm . – Rung t\u00e2m tr\u01b0\u01a1ng (RTTr) \u1edf m\u1ecfm. – T2 m\u1ea1nh \u1edf \u0111\u00e1y tim – T2 t\u00e1ch \u0111\u00f4i – Ti\u1ebfng th\u1ed5i ti\u1ec1n t\u00e2m thu \u1edf gi\u1eefa tim hay \u1edf m\u1ecfm – Ti\u1ebfng cl\u1eafc m\u1edf van hai l\u00e1 \u1edf m\u1ecfm ho\u1eb7c trong m\u1ecfm. \u00b7 C\u0169ng c\u00f3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p h\u1eb9p van hai l\u00e1 khi kh\u00e1m b\u1ec7nh kh\u00f4ng nghe \u0111\u01b0\u1ee3c g\u00ec m\u00e0 nh\u1edd bi\u1ebfn ch\u1ee9ng v\u00e0 nh\u1edd c\u1eadn l\u00e2m s\u00e0ng nh\u1ea5t l\u00e0 si\u00eau \u00e2m g\u1ecdi l\u00e0 h\u1eb9p van hai l\u00e1 \u201c c\u00e2m\u201d. 2. H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: +Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng: -Kh\u00f3 th\u1edf khi n\u1eb1m, c\u01a1n kh\u00f3 th\u1edf k\u1ecbch ph\u00e1t v\u1ec1 \u0111\u00eam, cu\u1ed1i c\u00f9ng l\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a suy tim to\u00e0n b\u1ed9. – \u0110au th\u1eaft ng\u1ef1c xu\u1ea5t hi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng + Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3: Tri\u1ec7u ch\u1ee9ng suy tim \u1ee9 huy\u1ebft (ph\u00f9 ph\u1ed5i…) b\u00e1o hi\u1ec7u ti\u00ean l\u01b0\u1ee3ng x\u1ea5u trong b\u1ec7nh h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u1ea5p. \u00b7 Nh\u00ecn: *V\u00f9ng \u0111\u1eadp r\u1ed9ng tr\u01b0\u1edbc tim ho\u1eb7c m\u1ecfm tim l\u1ec7ch tr\u00e1i do th\u1ea5t tr\u00e1i gi\u00e3n. *S\u1ed1 \u0111o huy\u1ebft \u00e1p: v\u1eabn b\u00ecnh th\u01b0\u1eddng n\u1ebfu h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 nh\u1eb9. Khi h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng huy\u1ebft \u00e1p t\u00e2m thu t\u0103ng cao, huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng gi\u1ea3m nhi\u1ec1u, t\u1ea1o ra ch\u00eanh l\u1ec7ch v\u1ec1 s\u1ed1 \u0111o huy\u1ebft \u00e1p l\u1edbn. \u00b7 S\u1edd: *M\u1ecfm tim th\u01b0\u1eddng \u0111\u1eadp m\u1ea1nh, t\u0103ng \u0111\u1ed9ng, l\u1ec7ch tr\u00e1i,khoang li\u00ean s\u01b0\u1eddn V ngo\u00e0i \u0111\u01b0\u1eddng gi\u1eefa \u0111\u00f2n, do th\u1ea5t tr\u00e1i gi\u00e3n. * Th\u01b0\u1eddng c\u00f3 rung miu t\u00e2m tr\u01b0\u01a1ng \u1edf khoang li\u00ean s\u01b0\u1eddn II tr\u00e1i, \u0111\u00f4i khi c\u00f3 c\u1ea3 rung miu t\u00e2m thu. \u00b7 Nghe: Ti\u1ebfng tim c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: * Ti\u1ebfng T1 m\u1edd khi h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i do hi\u1ec7n t\u01b0\u1ee3ng \u0111\u00f3ng s\u1edbm van hai l\u00e1 c\u0169ng nh\u01b0 gi\u1ea3m l\u1ef1c g\u00e2y \u0111\u00f3ng van. * Th\u00e0nh ph\u1ea7n ch\u1ee7 c\u1ee7a ti\u1ebfng T2 th\u01b0\u1eddng m\u1edd do c\u00e1c l\u00e1 van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u00f3ng kh\u00f4ng k\u00edn, th\u00e0nh ph\u1ea7n ph\u1ed5i c\u1ee7a T2 c\u0169ng hay b\u1ecb ti\u1ebfng th\u1ed5i t\u00e2m tr\u01b0\u01a1ng l\u1ea5n \u00e1p. *T2 t\u00e1ch \u0111\u00f4i s\u00e1t nhau ho\u1eb7c t\u00e1ch \u0111\u00f4i ngh\u1ecbch th\u01b0\u1eddng (tr\u00ean t\u00e2m thanh c\u01a1 \u0111\u1ed9ng \u0111\u1ed3, th\u00e0nh ph\u1ea7n ch\u1ee7 \u0111i sau th\u00e0nh ph\u1ea7n ph\u1ed5i) do th\u1eddi gian t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i b\u1ecb k\u00e9o d\u00e0i v\u00ec th\u1ec3 t\u00edch t\u1ed1ng m\u00e1u t\u0103ng. * Ti\u1ebfng T3 nghe \u0111\u01b0\u1ee3c khi gi\u1ea3m n\u1eb7ng ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i. * T4 hay c\u00f3, do nh\u0129 tr\u00e1i ph\u1ea3i b\u00f3p m\u00e1u xu\u1ed1ng bu\u1ed3ng th\u1ea5t tr\u00e1i \u0111\u00e3 gi\u1ea3m \u0111\u1ed9 gi\u00e3n. C\u00e2u 11 : M\u00f4 t\u1ea3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng c\u1ee7a b\u1ed9 m\u00e1y h\u00f4 h\u1ea5p ? 1. Ho: – M\u00f4 t\u1ea3: + Th\u1eddi gian xu\u1ea5t hi\u1ec7n: o C\u1ea5p: th\u01b0\u1eddng g\u1eb7p trong vi\u00eam c\u1ea5p t\u00ednh ph\u1ed5i ho\u1eb7c \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p. o M\u1ea1n t\u00ednh: th\u01b0\u1eddng g\u1eb7p trong b\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh. + Ch\u1ea5t ti\u1ebft: o Ho c\u00f3 \u0111\u1eddm: Sau khi ho kh\u1ea1c \u0111\u1eddm, c\u00f3 th\u1ec3 \u0111\u1eddm lo\u00e3ng hay \u0111\u1eb7c, l\u1eabn m\u00e1u m\u1ee7, b\u00e3 \u0111\u00e2u, s\u1ed1 l\u01b0\u1ee3ng \u00edt ho\u1eb7c nhi\u1ec1u. Th\u01b0\u1eddng ho l\u1ecdc x\u1ecdc, c\u00f3 khi ch\u1ea5t ti\u1ebft kh\u00f4ng ph\u1ea3i l\u00e0 \u0111\u1eddm v\u00ec \u0111\u1eddm \u0111\u00e3 b\u1ecb nu\u1ed1t nh\u1ea5t l\u00e0 \u1edf tr\u1ebb em. o Ho khan: l\u00e0 ho kh\u00f4ng c\u00f3 ch\u1ea5t ti\u1ebft, th\u01b0\u1eddng ho t\u1eebng c\u01a1n + Th\u1eddi gian: th\u1eddi gian n\u00e0o trong n\u0103m b\u1ecb ho, ho khi n\u00e0o – Gi\u00e1 tr\u1ecb v\u00e0 h\u01b0\u1edbng ch\u1ea9n \u0111o\u00e1n: + Ho c\u1ea5p: \u00b7 Do nhi\u1ec5m khu\u1ea9n vi\u00eam h\u1ecdng, vi\u00eam thanh qu\u1ea3n, vi\u00eam ph\u1ed5i c\u1ea5p, vi\u00eam ph\u1ed5i, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i. \u00b7 Do d\u1ecb \u1ee9ng: hen ph\u1ebf qu\u1ea3n. \u00b7 B\u1ec7nh \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u00edm t\u00e1i: ph\u00f9 ph\u1ed5i, bi\u1ec3u hi\u1ec7n v\u1ec1 ph\u1ed5i do b\u1ec7nh tim. \u00b7 H\u00edt ph\u1ea3i b\u1ee5i ho\u1eb7c c\u00e1c ch\u1ea5t k\u00edch th\u00edch. + Ho k\u00e9o d\u00e0i c\u00f3 k\u00e8m ch\u1ea5t ti\u1ebft: \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam ph\u1ed5i m\u1ea1n t\u00ednh nh\u1ea5t l\u00e0 BN h\u00fat thu\u1ed1c l\u00e1, thu\u1ed1c l\u00e0o + Ho khan k\u00e9o d\u00e0i: c\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn b\u1ec7nh c\u1ee7a thanh quanrm ung th\u01b0 ph\u1ed5i, x\u01a1 ph\u1ed5i ho\u1eb7c lao k\u00ea. 2. Kh\u1ea1c \u0111\u1eddm kh\u00f4ng c\u00f3 m\u00e1u: – M\u00f4 t\u1ea3: + Th\u1eddi gian kh\u1ea1c \u0111\u1eddm: m\u1edbi ho\u1eb7c c\u00f3 t\u1eeb l\u00e2u + Kh\u1ea1c t\u1ef1 nhi\u00ean hay sau khi thay \u0111\u1ed5i t\u01b0 th\u1ebf. + Gi\u1edd kh\u1ea1c \u0111\u1eddm, th\u01b0\u1eddng l\u00e0 v\u00e0o bu\u1ed5i s\u00e1ng + S\u1ed1 l\u1ea7n kh\u1ea1c \u0111\u1eddm, s\u1ed1 l\u01b0\u1ee3ng. + Trong tr\u01b0\u1eddng h\u1ee3p c\u1ea5p t\u00ednh, khi \u0111\u1eddm gi\u1ed1ng m\u1ee7 ta g\u1ecdi l\u00e0 \u1ed9c m\u1ee7 + T\u00ednh ch\u1ea5t c\u1ee7a \u0111\u1eddm: \u0111\u01a1m thanh d\u1ecbch, \u0111\u1eddm nh\u1ea7y, m\u1ee7, \u0111\u1eddm m\u1ee7 nh\u1ea7y, b\u00e3 \u0111\u1eadu o Trong tr\u1eafng, c\u00f3 b\u1ecdt \u0111\u00f3 l\u00e0 n\u01b0\u1edbc b\u1ecdt. o Trong v\u00e0 l\u1ecfng , ch\u1ea5t ti\u1ebft c\u1ee7a thanh m\u1ea1c o Tr\u1eafng v\u00e0 h\u01a1i s\u00e1m, ch\u1ea5t ti\u1ebft c\u1ee7a ni\u00eam m\u1ea1c. o Tr\u1eafng h\u1ed3ng x\u1ed1p, c\u1ee7a ph\u1ed5i. o V\u00e0ng nh\u1ea7y m\u1ee7. o Xanh: m\u1ee7 o \u0110\u1ecf n\u00e2u ho\u1eb7c m\u00e0u s\u1eaft g\u1ec9: c\u00f3 m\u00e1u + m\u00f9i c\u00f3 th\u1ec3 kh\u00f4ng m\u00f9i, nh\u01b0ng n\u1ebfu th\u1ed1i ngh\u0129 \u0111\u1ebfn nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n y\u1ebfm kh\u00ed – H\u01b0\u1edbng ch\u1ea9n \u0111o\u00e1n: + Kh\u1ea1c \u0111\u1eddm c\u1ea5p k\u00e8m c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m khu\u1ea9n. N\u1ebfu ch\u1ee5p ph\u1ed5i b\u00ecnh th\u01b0\u1eddng: vi\u00eam ph\u1ed5i c\u1ea5p N\u1ebfu ch\u1ee5p ph\u1ed5i c\u00f3 \u0111i\u1ec1u b\u1ea5t th\u01b0\u1eddng v\u00e0 n\u1ebfu kh\u1ea1c \u0111\u1eddm m\u00e0u g\u1ec9 s\u1eaft: vi\u00eam ph\u1ed5i do vi khu\u1ea9n Kh\u1ea1c \u0111\u1eddm m\u1ee7: \u00e1p xe ph\u1ed5i + Kh\u1ea1c \u0111\u1eddm c\u1ea5p, c\u00f3 c\u01a1 \u0111\u1ecba d\u1ecb \u1ee9ng: hen ph\u1ebf qu\u1ea3n + Kh\u1ea1c \u0111\u1eddm c\u1ea5p, bi\u1ec3u hi\u1ec7n b\u1ec7nh l\u00fd tim tr\u00e1i: ph\u00f9 ph\u1ed5i + Kh\u1ea1c \u0111\u1eddm k\u00e9o d\u00e0i Nh\u1ea7y ho\u1eb7c nh\u1ea7y m\u1ee7, s\u1ed1 l\u01b0\u1ee3ng nhi\u1ec1u, ho k\u00e9o d\u00e0i >3 th\u00e1ng\/n\u0103m v\u00e0 \u00edt nh\u1ea5t l\u00e0 2 n\u0103m li\u1ec1n : vi\u00eam ph\u1ebf qu\u1ea3n m\u1ea1n<\/p>\n

Nh\u1ea7y m\u1ee7 ho\u1eb7c m\u1ee7 th\u1eadt s\u1ef1, s\u1ed1 l\u01b0\u1ee3ng r\u1ea5t nhi\u1ec1u: gi\u00e3n ph\u1ebf qu\u1ea3n<\/p>\n

3. Kh\u00f3 th\u1edf:<\/p>\n

– \u0110\u1ecbnh ngh\u0129a: l\u00e0 t\u00ecnh tr\u1ea1ng kh\u00f3 kh\u0103n trong vi\u1ec7c th\u1edf.<\/p>\n

– B\u00ecnh th\u01b0\u1eddng nh\u1ecbp th\u1edf \u0111\u1ec1u, 14 – 20 l\u1ea7n\/ph\u00fat.<\/p>\n

– B\u1ea5t th\u01b0\u1eddng:<\/p>\n

+ Ng\u1eebng th\u1edf: kh\u00f4ng c\u00f2n h\u00f4 h\u1ea5p.<\/p>\n

+ Th\u1edf ch\u1eadm: nh\u1ecbp th\u1edf gi\u1ea3m. <8 + Th\u1edf nhanh: t\u1ea7n s\u1ed1 t\u0103ng. >25<\/p>\n

M\u00f4 t\u1ea3:<\/p>\n

+ L\u00fac xu\u1ea5t hi\u1ec7n: M\u1ea1n t\u00ednh, k\u00e9o d\u00e0i c\u00f3 th\u1ec3 do kh\u00f3 th\u1edf t\u1eeb tr\u01b0\u1edbc<\/p>\n

C\u1ea5p ho\u1eb7c m\u1edbi x\u1ea3y ra l\u1ea7n \u0111\u1ea7u, r\u1ea5t \u0111\u1ed9t ng\u1ed9t<\/p>\n

+ Y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t : kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n, h\u00edt ph\u1ea3i h\u01a1i \u0111\u1ed9c h\u00f3a ch\u1ea5t g\u00e2y d\u1ecb \u1ee9ng.<\/p>\n

+ Th\u1eddi k\u1ef3 th\u1edf:<\/p>\n

Kh\u00f3 th\u1edf khi h\u00edt v\u00e0o.<\/p>\n

Kh\u00f3 th\u1edf khi th\u1edf ra.<\/p>\n

+ T\u00ednh ch\u1ea5t:<\/p>\n

T\u1ea7n s\u1ed1 th\u1edf: \u00edt nh\u1ea5t ph\u1ea3i theo d\u00f5i trong 30 gi\u00e2y.<\/p>\n

C\u01b0\u1eddng \u0111\u1ed9: kh\u00f3 th\u1edf g\u1eafng s\u1ee9c hay khi n\u1eb1m. Chia ra 5 giai \u0111o\u1ea1n t\u00f9y theo s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a t\u00ecnh tr\u1ea1ng kh\u00f3 th\u1edf<\/p>\n

Giai \u0111o\u1ea1n 1: G\u1eafng s\u1ee9c nhi\u1ec1u.<\/p>\n

Giai \u0111o\u1ea1n 2: \u0110i l\u00ean g\u00e1c ho\u1eb7c \u0111i b\u00ecnh th\u01b0\u1eddng.<\/p>\n

Giai \u0111o\u1ea1n 3: \u0110i tr\u00ean b\u1ec1 m\u1eb7t ph\u1eb3ng c\u00f9ng v\u1edbi ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng, c\u00f9ng tu\u1ed5i v\u1edbi BN<\/p>\n

Giai \u0111o\u1ea1n 4: \u0110i b\u00ecnh th\u01b0\u1eddng tr\u00ean m\u1eb7t ph\u1eb3ng.<\/p>\n

Giai \u0111o\u1ea1n 5: L\u00e0m vi\u1ec7c b\u00ecnh th\u01b0\u1eddng h\u00e0ng ng\u00e0y<\/p>\n

– Gi\u00e1 tr\u1ecb tri\u1ec7u ch\u1ee9ng v\u00e0 h\u01b0\u1edbng ch\u1ea9n \u0111o\u00e1n:<\/p>\n

+ Kh\u00f3 th\u1edf c\u1ea5p:<\/p>\n

Kh\u00f3 th\u1edf v\u00e0o: th\u01b0\u1eddng do nguy\u00ean nh\u00e2n \u1edf thanh qu\u1ea3n nh\u01b0 vi\u00eam thanh qu\u1ea3n do virus, ung th\u01b0 thanh qu\u1ea3n<\/p>\n

Kh\u00f3 th\u1edf ra: hen ph\u1ebf qu\u1ea3n<\/p>\n

Kh\u00f3 th\u1edf hai th\u00ec: ph\u00f9 ph\u1ed5i c\u1ea5p, vi\u00eam ph\u1ed5i c\u1ea5p, t\u1eafc \u0110M ph\u1ed5i, x\u1eb9p ph\u1ed5i, TKMP, TDMP<\/p>\n

+ Kh\u00f3 th\u1edf li\u00ean t\u1ee5c: suy h\u00f4 h\u1ea5p, suy tim to\u00e0n b\u1ed9.<\/p>\n

+ Kh\u00f3 th\u1edf m\u1ea1n: COPD<\/p>\n

4. \u0110au ng\u1ef1c: M\u00f4 t\u1ea3<\/p>\n

– Th\u1eddi gian xu\u1ea5t hi\u1ec7n:<\/p>\n

+ C\u1ea5p t\u00ednh: b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 n\u00f3i r\u00f5 gi\u1edd \u0111au v\u1ecb tr\u00ed \u0111au<\/p>\n

+ M\u1ea1n t\u00ednh:\u0111au t\u0103ng l\u00ean ho\u1eb7c \u00e2m \u1ec9<\/p>\n

-V\u1ecb tr\u00ed \u0111au.<\/p>\n

– Y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t.<\/p>\n

+ \u0110 au sau g\u1eafng s\u1ee9c v\u00e0 gi\u1ea3m \u0111i sau khi ngh\u1ec9: ngh\u0129 \u0111\u1ebfn nguy\u00ean nh\u00e2n \u1edf \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/p>\n

+ \u0110au t\u0103ng khi ho v\u00e0 khi h\u00edt v\u00e0o s\u00e2u th\u01b0\u1eddng l\u00e0 nguy\u00ean n\u00e2n \u1edf m\u00e0ng ph\u1ed5i.<\/p>\n

– T\u00ednh ch\u1ea5t \u0111au:<\/p>\n

+ \u0110au nh\u01b0 th\u1eaft: suy v\u00e0nh.<\/p>\n

+ \u0110au nh\u01b0 dao \u0111\u00e2m: tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i.<\/p>\n

C\u00e2u 12: M\u00f4 t\u1ea3 c\u00e1ch kh\u00e1m h\u00f4 h\u1ea5p b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p nh\u00ecn v\u00e0 s\u1edd<\/p>\n

I. Nh\u00ecn:<\/p>\n

1. H\u00ecnh d\u00e1ng l\u1ed3ng ng\u1ef1c:<\/p>\n

– B\u00ecnh th\u01b0\u1eddng: L\u1ed3ng ng\u1ef1c ph\u1ea3i c\u00e2n \u0111\u1ed1i, c\u00e1c x\u01b0\u01a1ng s\u01b0\u1eddn h\u01a1i nghi\u00eang t\u1eeb tr\u00ean xu\u1ed1ng d\u01b0\u1edbi, t\u1eeb sau ra tr\u01b0\u1edbc, \u1edf ng\u01b0\u1eddi l\u1edbn b\u00ecnh th\u01b0\u1eddng t\u1ec9 l\u1ec7 \u0111\u01b0\u1eddng k\u00ednh tr\u01b0\u1edbc sau v\u1edbi \u0111\u01b0\u1eddng k\u00ednh ngang kho\u1ea3ng 1\/2, \u1edf tr\u1ebb em l\u00e0 1<\/p>\n

– Nh\u1eefng b\u1ea5t th\u01b0\u1eddng c\u00f3 th\u1ec3 g\u1eb7p:<\/p>\n

+ Bi\u1ebfn d\u1ea1ng:<\/p>\n

\u00b7 L\u1ed3ng ng\u1ef1c h\u00ecnh th\u00f9ng: \u0111\u01b0\u1eddng k\u00ednh tr\u01b0\u1edbc sau t\u0103ng l\u00ean g\u1eb7p trong gi\u00e3n ph\u1ebf nang.<\/p>\n

\u00b7 Kh\u00f4ng \u0111\u1ed1i x\u1ee9ng do co k\u00e9o, n\u1eeda l\u1ed3ng ng\u1ef1c b\u1ecb l\u00e9p l\u1ea1i, c\u00e1c x\u01b0\u01a1ng s\u01b0\u1eddn th\u00f5ng xu\u1ed1ng h\u01a1n, kho\u1ea3ng li\u00ean s\u01b0\u1eddn h\u1eb9p ( g\u1eb7p trong di ch\u1ee9ng tr\u00e0n d\u1ecbch, tr\u00e0n m\u00e1u m\u00e0ng ph\u1ed5i\u2026)<\/p>\n

\u00b7 Kh\u00f4ng \u0111\u1ed1i x\u1ee9ng trong \u0111\u00f3 1 n\u1eeda l\u1ed3ng ng\u1ef1c l\u1ea1i ph\u00ecnh l\u00ean to ra, c\u00e1c x\u01b0\u01a1ng s\u01b0\u1eddn n\u1eb1m ngang, kho\u1ea3ng lien s\u01b0\u1eddn gi\u00e3n r\u1ed9ng ( g\u1eb7p trong tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i\u2026)<\/p>\n

\u00b7 Bi\u1ebfn d\u1ea1ng c\u1ed9t s\u1ed1ng: v\u1eb9o, g\u00f9, x\u01b0\u01a1ng \u1ee9c b\u1ecb nh\u00f4 ra ph\u00eda tr\u01b0\u1edbc.<\/p>\n

+ Tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7:c\u00e1c m\u1ea1ch m\u00e1u \u1edf n\u1ed3ng ng\u1ef1c gi\u00e3n to ra ngo\u1eb1n ngo\u00e8o n\u1ed5i tr\u00ean m\u1eb7t da th\u01b0\u1eddng k\u00e8m theo gi\u00e3n TM c\u1ed5, ch\u1ee9ng t\u1ecf c\u00f3 ch\u00e8n \u00e9p TM ch\u1ee7 tr\u00ean<\/p>\n

+ Ph\u00f9:<\/p>\n

\u00b7 Ph\u00f9 hai b\u00ean t\u1eeb th\u1eaft l\u01b0ng tr\u1edf l\u00ean g\u1ecdi l\u00e0 ph\u00f9 \u00e1o kho\u00e1c.<\/p>\n

\u00b7 Ph\u00f9 m\u1ed9t b\u00ean, nh\u1ea5t l\u00e0 v\u00f9ng \u0111\u00e1y l\u1ed3ng ng\u1ef1c th\u1eebng th\u1ea5y trong tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i m\u1ee7<\/p>\n

2. Di \u0111\u1ed9ng c\u1ee7a th\u1edf:<\/p>\n

– T\u1ea7n s\u1ed1, nh\u1ecbp th\u1edf \u0111\u1ec1u hay kh\u00f4ng \u0111\u1ec1u.<\/p>\n

– Ki\u1ec3u th\u1edf: th\u1edf b\u1ee5ng hay th\u1edf ng\u1ef1c.<\/p>\n

– \u0110\u1ed9 co gi\u00e3n c\u1ee7a l\u1ed3ng ng\u1ef1c: c\u00f3 th\u1ec3 gi\u00e3n to\u00e0n b\u1ed9 trong gi\u00e3n ph\u1ebf nang ho\u1eb7c hen n\u1eb7ng.<\/p>\n

– Co k\u00e9o c\u00e1c c\u01a1 h\u00f4 h\u1ea5p.<\/p>\n

* \u0110i\u1ec1u c\u1ea7n nh\u1edb v\u1ec1 h\u00ecnh d\u00e1ng l\u1ed3ng ng\u1ef1c:<\/p>\n

– Gi\u00e3n c\u0103ng to\u00e0n b\u1ed9:<\/p>\n

+ Gi\u00e3n ph\u1ebf nang.<\/p>\n

+ Vi\u00eam ph\u1ebf qu\u1ea3n m\u00e3n t\u00ednh.<\/p>\n

+ Hen ph\u1ebf qu\u1ea3n.<\/p>\n

– Bi\u1ebfn d\u1ea1ng c\u1ee7a x\u01b0\u01a1ng:<\/p>\n

+ V\u1eb9o g\u00f9.<\/p>\n

+ L\u1ed3ng ng\u1ef1c h\u00ecnh th\u00f9ng.<\/p>\n

+ G\u1eaby x\u01b0\u01a1ng s\u01b0\u1eddn.<\/p>\n

– Kh\u00f4ng \u0111\u1ed1i x\u1ee9ng v\u00e0 ph\u00ecnh:<\/p>\n

+ Tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i.<\/p>\n

+ Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i.<\/p>\n

+ K\u00e9n h\u01a1i.<\/p>\n

– Kh\u00f4ng \u0111\u1ed1i x\u1ee9ng v\u00e0 co k\u00e9o:<\/p>\n

+ X\u1eb9p ph\u1ed5i.<\/p>\n

+ Di ch\u1ee9ng c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i.<\/p>\n

2. S\u1edd:B\u1ed5 sung cho nh\u1eefng d\u1ea5u hi\u1ec7u \u0111\u00e3 ghi nh\u1eadn \u0111\u01b0\u1ee3c khi nh\u00ecn v\u1ec1 nh\u1ecbp th\u1edf v\u00e0 bi\u00ean \u0111\u1ed9. Ch\u1ee7 y\u1ebfu \u0111\u1ec3 bi\u1ebft rung thanh.<\/p>\n

– Ph\u01b0\u01a1ng ph\u00e1p: \u00e1p s\u00e1t l\u00f2ng b\u00e0n tay l\u00ean th\u00e0nh ng\u1ef1c \u1edf c\u00e1c v\u1ecb tr\u00ed \u0111\u1ed1i x\u1ee9ng v\u00e0 b\u1ea3o b\u1ec7nh nh\u00e2n \u0111\u1ebfm 1, 2, 3. C\u1ea7n so s\u00e1nh c\u00e1c v\u00f9ng \u0111\u1ed1i x\u1ee9ng c\u1ee7a th\u00e0nh ng\u1ef1c.<\/p>\n

– K\u1ebft qu\u1ea3:<\/p>\n

+ B\u00ecnh th\u01b0\u1eddng \u00e2m ph\u00e1t ra t\u1eeb thanh qu\u1ea3n truy\u1ec1n qua th\u00e0nh ng\u1ef1c, b\u00e0n tay c\u00f3 hi\u1ec7nt\u01b0\u1ee3ng rung nh\u1eb9.<\/p>\n

+ Rung thanh t\u0103ng l\u00e0 tr\u01b0\u1eddng h\u1ee3p \u0111\u00f4ng \u0111\u1eb7c c\u1ee7a v\u00f9ng ph\u1ed5i ph\u00eda d\u01b0\u1edbi.<\/p>\n

+ Rung thanh gi\u1ea3m ho\u1eb7c m\u1ea5t; ch\u1ee9ng t\u1ecf c\u00f3 d\u1ecbch ho\u1eb7c h\u01a1i ng\u0103n c\u00e1ch gi\u1eefa nhu m\u00f4 ph\u1ed5i v\u00e0 tay c\u1ee7a ng\u01b0\u1eddi kh\u00e1m. Th\u00e0nh ng\u1ef1c d\u00e0y c\u0169ng l\u00e0m rung thanh gi\u1ea3m.<\/p>\n

+ S\u1edd c\u0169ng c\u00f2n cho bi\u1ebft: c\u00e1c \u0111i\u1ec3m \u0111au, h\u1ea1ch, \u0111\u1eb7c bi\u1ec7t l\u00e0 h\u1ea1ch th\u01b0\u1ee3ng \u0111\u00f2n<\/p>\n

+ \u0110i\u1ec1u c\u1ea7n nh\u1edb khi s\u1edd n\u1ebfu rung thanh t\u0103ng: \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i<\/p>\n

Rung thanh m\u1ea5t: TDMP, TKMPC\u00e2u 13 : M\u00f4 t\u1ea3 c\u00e1ch kh\u00e1m h\u00f4 h\u1ea5p b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p g\u00f5 v\u00e0 nghe<\/p>\n

1. G\u00f5.<\/p>\n

C\u1ea7n g\u00f5 nhi\u1ec1u n\u01a1i tr\u00ean l\u1ed3ng ng\u1ef1c v\u00e0 c\u1ea7n so s\u00e1nh hai b\u00ean v\u1edbi nhau<\/p>\n

\u2013 Ph\u01b0\u01a1ng ph\u00e1p g\u00f5: c\u00f3 hai ph\u01b0\u01a1ng ph\u00e1p<\/p>\n

+ g\u00f5 tr\u1ef1c ti\u1ebfp:\u0111\u1ea7u c\u00e1c ng\u00f3n tay u\u1ea5n cong r\u1ed3i g\u00f5 tr\u1ef1c ti\u1ebfp v\u00e0o th\u00e0nh ng\u1ef1c \u1edf c\u00e1c \u0111i\u1ec3m kh\u00e1c nhau<\/p>\n

+ g\u00f5 gi\u00e1n ti\u1ebfp- D\u00f9ng \u0111\u1ea7u ng\u00f3n tay gi\u1eefa c\u1ee7a b\u00e0n tay ph\u1ea3i \u0111\u1eadp v\u00e0o ng\u00f3n tr\u1ecf hay ng\u00f3n gi\u1eefa c\u1ee7a b\u00e0n tay tr\u00e1i \u00e1p s\u00e1t v\u00e0o th\u00e0nh ng\u1ef1c v\u00e0 ng\u00f3n tay \u0111\u1ec3 song song v\u1edbi khoang li\u00ean s\u01b0\u1eddn. \u0110\u1ed9ng t\u00e1c c\u1ee7a tay ph\u1ea3i \u0111\u1eadp b\u1eb1ng kh\u1edbp c\u1ed5 tay, ph\u1ea3i g\u00f5 \u0111\u1ec1u tay v\u00e0 so s\u00e1nh c\u00e1c v\u00f9ng \u0111\u1ed1i x\u1ee9ng.<\/p>\n

\u2013 K\u1ebft qu\u1ea3:<\/p>\n

+ B\u00ecnh th\u01b0\u1eddng: g\u00f5 th\u1ea5y trong.<\/p>\n

+ Nghe th\u1ea5y \u0111\u1ee5c khi \u0111\u1ed9 trong gi\u1ea3m, \u00e2m s\u1eafc tr\u1ea7m, g\u1eb7p trong tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, vi\u00eam ph\u1ed5i.<\/p>\n

+ Nghe th\u1ea5y vang tr\u1ed1ng l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng qu\u00e1 trong g\u1eb7p trong tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, gi\u00e3n ph\u1ebf nang.<\/p>\n

\u0110i\u1ec1u c\u1ea7n ghi nh\u1edb khi g\u00f5:<\/p>\n

– \u0110\u1ee5c: TDMP; vi\u00eam ph\u1ed5i<\/p>\n

– Vang tr\u1ed1ng: TKMP; gi\u00e3n ph\u1ebf nang<\/p>\n

2. Nghe:<\/p>\n

– Ph\u01b0\u01a1ng ph\u00e1p:\u0110\u1ec3 b\u1ec7nh nh\u00e2n th\u1edf s\u00e2u, th\u1edf \u0111\u1ec1u, th\u1edf m\u0169i. \u0110\u1eb7t \u1ed1ng nghe tr\u00ean to\u00e0n b\u1ed9 l\u1ed3ng ng\u1ef1c 2 b\u00ean, ph\u1ea3i nghe khi \u0111\u1ec3 b\u1ec7nh nh\u00e2n th\u1edf \u0111\u1ec1u b\u00ecnh th\u01b0\u1eddng, l\u00fac th\u1edf ra m\u1ea1nh, b\u1ea3o b\u1ec7nh nh\u00e2n ho ho\u1eb7c n\u00f3i. Nghe c\u1ea7n so s\u00e1nh hai b\u00ean.<\/p>\n

\u1ede ph\u00eda sau nghe \u1edf hai \u0111\u00e1y, v\u00f9ng li\u00ean b\u1ea3 c\u1ed9t s\u1ed1ng, v\u00f9ng tr\u00ean b\u1ea3.<\/p>\n

\u01a0 ph\u00eda tr\u01b0\u1edbc kh\u00f4ng n\u00ean qu\u00ean nghe \u1edf h\u00f5m th\u01b0\u1ee3ng \u0111\u00f2n, v\u00f9ng l\u00e1ch.<\/p>\n

– K\u1ebft qu\u1ea3:<\/p>\n

+ Ti\u1ebfng th\u1edf b\u00ecnh th\u01b0\u1eddng: c\u00f3 2 lo\u1ea1i<\/p>\n

Ti\u1ebfng th\u1edf kh\u00ed ph\u1ebf qu\u1ea3n: Nghe th\u00f4, li\u00ean t\u1ee5c, c\u01b0\u1eddng \u0111\u1ed9 l\u1edbn v\u00e0 nghe \u0111\u01b0\u1ee3c \u1edf c\u1ea3 2 th\u00ec. Ti\u1ebfng n\u00e0y do lu\u1ed3ng kh\u00ed xo\u00e1y trong kh\u00ed qu\u1ea3n v\u00e0 ph\u1ebf qu\u1ea3n l\u1edbn.<\/p>\n

R\u00ec r\u00e0o ph\u1ebf nang: L\u00e0 nh\u1eefng ti\u1ebfng li\u00ean t\u1ee5c, \u00eam d\u1ecbu, c\u01b0\u1eddng \u0111\u1ed9 th\u1ea5p, k\u00e9o d\u00e0i su\u1ed1t th\u1eddi k\u1ef3 h\u00edt v\u00e0o v\u00e0 \u0111\u1ea7u th\u1eddi k\u1ef3 th\u1edf ra.<\/p>\n

+ Nh\u1eefng ti\u1ebfng b\u1ea5t th\u01b0\u1eddng:<\/p>\n

\u00d8 R\u00ec r\u00e0o ph\u1ebf nang c\u00f3 th\u1ec3:M\u1ea5t khi c\u00f3 TDMP ho\u1eb7c tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, ph\u1ed5i b\u1ecb \u0111\u00f4ng \u0111\u1eb7c.<\/p>\n

Gi\u1ea3m khi th\u00e0nh ng\u1ef1c qu\u00e1 d\u00e0y, gi\u00e3n ph\u1ebf nang.<\/p>\n

\u00d8 Ti\u1ebfng kh\u00ed ph\u1ebf qu\u1ea3n: Khi b\u1ea5t th\u01b0\u1eddng ti\u1ebfng n\u00e0y truy\u1ec1n ra ta nghe \u0111\u01b0\u1ee3c trong m\u1ed9t s\u1ed1 qu\u00e1 tr\u00ecnh b\u1ec7nh l\u00fd g\u1ecdi l\u00e0 ti\u1ebfng th\u1ed5i.<\/p>\n

o Ti\u1ebfng th\u1ed5i m\u00e0ng ph\u1ed5i: \u00cam, xa x\u0103m, nh\u1eb9, r\u00f5 \u1edf th\u1eddi k\u1ef3 th\u1edf ra. Nghe \u0111\u01b0\u1ee3c \u1edf ph\u00eda tr\u00ean n\u01a1i c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i th\u1ec3 trung b\u00ecnh.<\/p>\n

o Ti\u1ebfng th\u1ed5i \u1ed1ng: M\u1ea1nh, th\u00f4, \u00e2m \u0111\u1ed9 cao, nghe r\u00f5 \u1edf c\u1ea3 hai th\u00ec, g\u1eb7p trong h\u1ed9i ch\u1ee9ng \u0111\u00f4ng \u0111\u1eb7c, l\u00e0 ti\u1ebfng kh\u00ed ph\u1ebf qu\u1ea3n gi\u1ea3m truy\u1ec1n qua m\u00f4i tr\u01b0\u1eddng \u0111\u00f4ng \u0111\u1eb7c.<\/p>\n

o Ti\u1ebfng th\u1ed5i v\u00f2: Nghe nh\u01b0 ti\u1ebfng kim kh\u00ed, \u00e2m \u0111\u1ed9 cao, r\u00f5 \u1edf th\u1eddi k\u1ef3 th\u1edf ra. Ti\u1ebfng n\u00e0y ph\u00e1t sinh do s\u1ef1 c\u1ed9ng h\u01b0\u1edfng c\u1ee7a ti\u1ebfng th\u1edf b\u00ecnh th\u01b0\u00f2ng khi qua m\u1ed9t t\u00fai h\u01a1i (tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i khu tr\u00fa).<\/p>\n

o Ti\u1ebfng th\u1ed5i hang: M\u1ea1nh, \u00e2m s\u1eafc r\u1ed7ng, \u00e2m \u0111\u1ed9 cao, nghe r\u00f5 \u1edf th\u1eddi k\u1ef3 th\u1edf v\u00e0o. Ph\u00e1t sinh do s\u1ef1 truy\u1ec1n c\u1ee7a ti\u1ebfng kh\u00ed ph\u1ebf qu\u1ea3n qua m\u1ed9t hang r\u1ed7ng trong nhu m\u00f4 ph\u1ed5i ( hang lao, \u00e1p xe ph\u1ed5i).<\/p>\n

o Ran r\u00edt: \u00c2m \u0111\u1ed9 cao, nghe nh\u01b0 ti\u1ebfng chim r\u00edu r\u00edt ho\u1eb7c ti\u1ebfng gi\u00f3 th\u1ed5i m\u1ea1nh qua khe c\u1eeda.<\/p>\n

o Ran ng\u00e1y: \u00c2m \u0111\u1ed9 tr\u1ea7m, nghe nh\u01b0 ti\u1ebfng ng\u00e1y ng\u1ee7, nghe r\u00f5 \u1edf c\u1ea3 hai th\u00ec.<\/p>\n

o Ran n\u1ed5: Nghe kh\u00f4 nh\u1ecf, \u00e2m \u0111\u1ed9 cao ( nghe nh\u01b0 ti\u1ebfng rang mu\u1ed1i) , r\u00f5 \u1edf k\u1ef3 th\u1edf v\u00e0o v\u00e0 kh\u00f4ng thay \u0111\u1ed5i khi ho.<\/p>\n

o Ran \u1ea9m: Nghe l\u1ecdc x\u1ecdc kh\u00f4ng \u0111\u1ec1u ( nh\u01b0 ti\u1ebfng n\u01b0\u1edbc s\u00f4i), m\u1ea1nh, r\u00f5 \u1edf c\u1ea3 hai th\u00ec v\u00e0 thay \u0111\u1ed5i khi ho.<\/p>\n

o Ti\u1ebfng c\u1ecd m\u00e0ng ph\u1ed5i:<\/p>\n

Do 2 l\u00e1 c\u1ee7a m\u00e0ng ph\u1ed5i c\u1ecd v\u00e0o nhau. Nghe kh\u00f4, th\u00f4 r\u00e1p, nghe r\u00f5 c\u1ea3 hai th\u00ec.<\/p>\n

G\u1eb7p trong giai \u0111o\u1ea1n \u0111\u1ea7u sau khi \u0111\u00e3 b\u1edbt c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i.<\/p>\n

C\u00e2u 14: Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i ?<\/p>\n

I. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng: Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng do nhi\u1ec1u nguy\u00ean nh\u00e2n n\u00ean tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u0169ng r\u1ea5t ph\u1ee9c t\u1ea1p.<\/p>\n

1. Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n:T\u00f9y theo nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh: c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n r\u00f5 r\u1ec7t<\/p>\n

+ S\u1ed1t: s\u1ed1t v\u1eeba trong tr\u00e0n d\u1ecbch thanh t\u01a1, s\u1ed1t cao dao \u0111\u1ed9ng trong tr\u00e0n d\u1ecbch m\u1ee7 , kh\u00f4ng s\u1ed1t trong tr\u00e0n d\u1ecbch m\u1ea1n t\u00ednh<\/p>\n

+ Nh\u1ecbp tim nhanh, m\u1ea1ch nhanh, m\u1ec7t m\u1ecfi, th\u1ec3 tr\u1ea1ng suy s\u1ee5p…<\/p>\n

2. Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:<\/p>\n

+ \u0110au ng\u1ef1c: \u0110au nh\u00f3i ho\u1eb7c \u00e2m \u1ec9, \u0111au \u1edf b\u00ean ng\u1ef1c c\u00f3 tr\u00e0n d\u1ecbch. Th\u01b0\u1eddng \u0111au \u1edf giai \u0111o\u1ea1n vi\u00eam, c\u00f2n khi c\u00f3 tr\u00e0n d\u1ecbch nhi\u1ec1u th\u00ec \u0111\u1ee1 \u0111au<\/p>\n

+ Ho: Th\u01b0\u1eddng ho khan, ho t\u0103ng l\u00ean khi thay \u0111\u1ed5i t\u01b0 th\u1ebf.<\/p>\n

+ Kh\u00f3 th\u1edf: T\u1ef7 l\u1ec7 thu\u1eadn v\u1edbi s\u1ed1 l\u01b0\u1ee3ng d\u1ecbch trong khoang m\u00e0ng ph\u1ed5i.<\/p>\n

3. Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:<\/p>\n

v Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i th\u1ec3 t\u1ef1 do:<\/p>\n

– Nh\u00ecn: L\u1ed3ng ng\u1ef1c b\u00ean c\u00f3 tr\u00e0n d\u1ecbch h\u01a1i nh\u00f4 l\u00ean, kho\u1ea3ng li\u00ean s\u01b0\u1eddn r\u1ed9ng h\u01a1n, khi th\u1edf \u0111\u1ed9 di \u0111\u1ed9ng c\u1ee7a l\u1ed3ng ng\u1ef1c k\u00e9m h\u01a1n ph\u00eda kh\u00f4ng c\u00f3 tr\u00e0n d\u1ecbch.<\/p>\n[\u200bIMG]- S\u1edd: Rung thanh v\u00f9ng c\u00f3 tr\u00e0n d\u1ecbch gi\u1ea3m ho\u1eb7c m\u1ea5t ho\u00e0n to\u00e0n.<\/p>\n

H.ch\u1ee9ng 3 gi\u1ea3m – G\u00f5: \u0110\u1ee5c \u1edf v\u00f9ng c\u00f3 tr\u00e0n d\u1ecbch<\/p>\n

– Nghe: R\u00ec r\u00e0o ph\u1ebf nang gi\u1ea3m ho\u1eb7c m\u1ea5t. C\u00f3 th\u1ec3 nghe th\u1ea5y ti\u1ebfng c\u1ecd m\u00e0ng ph\u1ed5i trong giai \u0111o\u1ea1n \u0111\u1ea7u v\u00e0 giai \u0111o\u1ea1n khi \u0111\u00e3 r\u00fat nhi\u1ec1u d\u1ecbch.<\/p>\n

v Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i th\u1ec3 khu tr\u00fa: L\u00e2m s\u00e0ng th\u01b0\u1eddng kh\u00f3 ph\u00e1t hi\u1ec7n, ph\u1ea3i c\u00f3 X Quang k\u1ebft h\u1ee3p v\u1edbi ch\u1ecdc d\u00f2 m\u1edbi c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c.<\/p>\n

T\u00f9y d\u1ecbch nhi\u1ec1u ho\u1eb7c \u00edt s\u1ebd th\u1ea5y di\u1ec7n m\u1edd l\u1edbn ho\u1eb7c nh\u1ecf.<\/p>\n

II. Nguy\u00ean nh\u00e2n:<\/p>\n

1. D\u1ecbch th\u1ea5m:<\/p>\n

C\u00f3 ph\u1ea3n \u1ee9ng Rivalta (-), t\u1ef7 l\u1ec7 Protein < 30g\/l\u00edt, c\u00f3 \u00edt t\u1ebf b\u00e0o, th\u01b0\u1eddng g\u1eb7p trong c\u00e1c b\u1ec7nh g\u00e2y \u1ee9 n\u01b0\u1edbc trong c\u01a1 th\u1ec3 nh\u01b0: \u2013 Suy tim to\u00e0n b\u1ed9. \u2013 X\u01a1 gan. \u2013 H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0. \u2013 suy dinh d\u01b0\u1ee1ng 2. D\u1ecbch ti\u1ebft: C\u00f3 ph\u1ea3n \u1ee9ng Rivalta (+), t\u1ef7 l\u1ec7 Protein > 30 g\/l\u00edt, c\u00f3 nhi\u1ec1u t\u1ebf b\u00e0o th\u01b0\u1eddng g\u1eb7p trong vi\u00eam ho\u1eb7c ph\u1ea3n \u1ee9ng k\u00edch th\u00edch m\u00e0ng ph\u1ed5i nh\u01b0:
\nTr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do lao.
\nTr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i do ung th\u01b0: ung th\u01b0 ph\u1ebf qu\u1ea3n, ung th\u01b0 ph\u1ed5i, ung th\u01b0 m\u00e0ng ph\u1ed5i ho\u1eb7c ung th\u01b0 t\u1eeb n\u01a1i kh\u00e1c di c\u0103n v\u00e0o m\u00e0ng ph\u1ed5i
\nVi\u00eam ph\u1ed5i m\u00e0ng ph\u1ed5i.
\nNh\u1ed3i m\u00e1u ph\u1ed5i.
\nVi\u00eam ph\u1ed5i do vi khu\u1ea9n.
\n\u00c1p xe ph\u1ed5i v\u1ee1 v\u00e0o m\u00e0ng ph\u1ed5i.
\n\u00c1p xe gan v\u1ee1 l\u00ean ph\u1ed5i
\nNgo\u00e0i ra c\u00f2n tr\u00e0n d\u1ecbch c\u00f3 ch\u1ee9a nhi\u1ec1u cholesterol, d\u01b0\u1ee1ng ch\u1ea5p nh\u01b0ng r\u1ea5t hi\u1ebfm khi g\u1eb7p<\/p>\n

C\u00e2u 15: V\u1ecb tr\u00ed ch\u1ecdc d\u00f2 m\u00e0ng ph\u1ed5i v\u00e0 XQ ph\u1ed5i th\u1eb3ng:<\/p>\n

*V\u1ecb tr\u00ed ch\u1ecdc d\u00f2 m\u00e0ng ph\u1ed5i<\/p>\n

-Khoang li\u00ean s\u01b0\u1eddn 7 – 8 tr\u00ean \u0111\u01b0\u1eddng n\u00e1ch gi\u1eefa.<\/p>\n

-N\u1ebfu d\u1ecbch nhi\u1ec1u c\u00f3 th\u1ec3 ch\u1ecdc \u1edf khoang li\u00ean s\u01b0\u1eddn 2 – 3.<\/p>\n

-D\u1ecbch m\u1ee7: \u0111\u01b0a \u1ed1ng th\u00f4ng qua khoang li\u00ean s\u01b0\u1eddn 2 – 3.<\/p>\n

-Tr\u00e0n d\u1ecbch, tr\u00e0n kh\u00ed d\u00f9ng c\u1ea3 hai \u0111\u01b0\u1eddng tr\u00ean v\u00e0 d\u01b0\u1edbi.<\/p>\n

* \u0110\u1ecdc phim Xquang ph\u1ed5i th\u1eb3ng<\/p>\n

-X\u00e1c \u0111\u1ecbnh k\u1ef9 thu\u1eadt ch\u1ee5p: c\u00e2n \u0111\u1ed1i, \u0111\u1ed9 xuy\u00ean c\u1ee7a tia, \u0111\u1ed9 t\u01b0\u01a1ng ph\u1ea3n \u0111en, tr\u1eafng, ch\u1ee5p th\u1edf v\u00e0o s\u00e2u.<\/p>\n

-X\u00e1c \u0111\u1ecbnh h\u00ecnh \u1ea3nh gi\u1ea3, nhi\u1ec5u: h\u00ecnh \u1ea3nh gi\u1ea3 tr\u00e0n kh\u00ed, h\u00ecnh \u1ea3nh gi\u1ea3 hang.<\/p>\n

-Quan s\u00e1t t\u1eeb th\u00e0nh ng\u1ef1c, x\u01b0\u01a1ng s\u01b0\u1eddn v\u00f2m ho\u00e0nh, t\u00fai h\u01a1i d\u1ea1 d\u00e0y trung th\u1ea5t nhu m\u00f4 ph\u1ed5i.<\/p>\n

-X\u00e1c \u0111\u1ecbnh c\u00e1c h\u00ecnh \u1ea3nh b\u1ea5t th\u01b0\u1eddng: c\u1ee5c b\u1ed9, lan t\u1ecfa, 1 b\u00ean ho\u1eb7c c\u1ea3 2 b\u00ean ph\u1ed5i, c\u00f3 x\u00e2m l\u1ea5n c\u00e1c c\u1ea5u tr\u00fac xung quanh kh\u00f4ng.<\/p>\n

-X\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed, m\u00f4 t\u1ea3 h\u00ecnh th\u1ec3, s\u1eafp x\u1ebfp c\u00e1c d\u1ea5u hi\u1ec7u Xquang v\u00e0o c\u00e1c h\u1ed9i ch\u1ee9ng Xquang ph\u1ed5i.<\/p>\n

-\u0110\u1ed1i chi\u1ebfu v\u1edbi h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng tr\u00ean phim nghi\u00eang, phim c\u0169 (n\u1ebfu c\u00f3).<\/p>\n

-\u0110\u1ed1i chi\u1ebfu v\u1edbi ti\u1ebfn tri\u1ec3n l\u00e2m s\u00e0ng, ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1ec1 Xquang tr\u01b0\u1edbc khi \u0111\u01b0a ra h\u01b0\u1edbng ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh.<\/p>\n

C\u00e2u 16:Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a, nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i ?<\/p>\n

I. \u0110\u1ecbnh ngh\u0129a:<\/p>\n

Tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i l\u00e0 s\u1ef1 c\u00f3 kh\u00ed m\u1ed9t c\u00e1ch b\u1ea5t th\u01b0\u1eddng trong khoang m\u00e0ng ph\u1ed5i, gi\u1eefa m\u00e0ng ph\u1ed5i th\u00e0nh v\u00e0 m\u00e0ng ph\u1ed5i t\u1ea1ng do t\u1ed5n th\u01b0\u01a1ng nh\u1eefng l\u00e1 n\u00e0y g\u00e2y x\u1eb9p m\u1ed9t ph\u1ea7n hay to\u00e0n b\u1ed9 m\u1ed9t ph\u1ed5i.<\/p>\n

II. C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i:<\/p>\n

Lao, x\u01a1 h\u00f3a k\u00e9n, ch\u1ea5n th\u01b0\u01a1ng ng\u1ef1c, t\u1ee5 c\u1ea7u m\u00e0ng ph\u1ed5i, hen ph\u1ebf qu\u1ea3n, kh\u00ed ph\u1ebf th\u1ee7ng, tai bi\u1ebfn th\u1edf m\u00e1y, do can thi\u1ec7p m\u1ed9t s\u1ed1 th\u1ee7 thu\u1eadt.<\/p>\n

T\u1ef1 ph\u00e1t: > 80% tr\u01b0\u1eddng h\u1ee3p, th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i (thanh ni\u00ean)<\/p>\n

III. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:<\/p>\n

1. Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n:<\/p>\n

T\u00f9y theo nguy\u00ean nh\u00e2n m\u1ee9c \u0111\u1ed9 v\u00e0 th\u1ec3 lo\u1ea1i c\u1ee7a tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i:<\/p>\n

– T\u00edm t\u00e1i, th\u1edf nhanh<\/p>\n

– M\u1ea1ch nhanh , huy\u1ebft \u00e1p h\u1ea1<\/p>\n

– N\u1eb7ng c\u00f3 th\u1ec3 tr\u1ee5y m\u1ea1ch, ng\u1eebng tim<\/p>\n

2. Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:<\/p>\n

– \u0110au ng\u1ef1c: \u0110\u1ed9t ng\u1ed9t, d\u1eef d\u1ed9i nh\u01b0 dao \u0111\u00e2m \u1edf v\u00f9ng l\u1ed3ng ng\u1ef1c c\u00f3 tr\u00e0n kh\u00ed, \u0111au t\u0103ng l\u00ean th\u00ec h\u00edt v\u00e0o s\u00e2u ho\u1eb7c khi ho.<\/p>\n

– Ho: Ho khan, khi thay \u0111\u1ed5i t\u01b0 th\u1ebf, ho t\u1eebng c\u01a1n ng\u1eafn. \u00cdt g\u1eb7p h\u01a1n tri\u1ec7u ch\u1ee9ng \u0111au ng\u1ef1c, kh\u00f3 th\u1edf<\/p>\n

– Kh\u00f3 th\u1edf: Xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t v\u00e0 \u0111i li\u1ec1n sau d\u1ea5u hi\u1ec7u \u0111au. M\u1ee9c \u0111\u1ed9 kh\u00f3 th\u1edf t\u00f9y m\u1ee9c \u0111\u1ed9 tr\u00e0n kh\u00edv\u00e0 kh\u1ea3 n\u0103ng h\u00f4 h\u1ea5p c\u1ee7a ph\u00eda ph\u1ed5i c\u00f2n l\u1ea1i.<\/p>\n

3. Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:<\/p>\n

– Nh\u00ecn: N\u1eeda l\u1ed3ng ng\u1ef1c b\u00ean tr\u00e0n kh\u00ed k\u00e9m di \u0111\u1ed9ng, c\u0103ng ph\u1ed3ng, kho\u1ea3ng li\u00ean s\u01b0\u1eddn gi\u00e3n r\u1ed9ng.<\/p>\n[\u200bIMG]\n

– S\u1edd: Rung thanh m\u1ea5t.<\/p>\n

– [\u200bIMG]G\u00f5: G\u00f5 vang tr\u1ed1ng. Tam ch\u1ee9ng Galliard.<\/p>\n

– Nghe: R\u00ec r\u00e0o ph\u1ebf nang m\u1ea5t.<\/p>\n

C\u00e2u 17: Tr\u00ecnh b\u00e0y kh\u00e1m v\u1eadn \u0111\u1ed9ng<\/p>\n

I. Kh\u00e1m v\u1eadn \u0111\u1ed9ng t\u1ef1 ch\u1ee7<\/p>\n

1. M\u1ed9t s\u1ed1 c\u00e1ch kh\u00e1m: NB \u1edf nhi\u1ec1u t\u01b0 th\u1ebf nh\u01b0 ng\u1ed3i \u0111\u1ee9ng n\u1eb1m\u2026\u1edf \u0111\u00e2y th\u01b0\u1eddng kh\u00e1m \u1edf t\u01b0 th\u1ebf n\u1eb1m.<\/p>\n

– H\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n l\u00e0m m\u1ed9t s\u1ed1 \u0111\u1ed9ng t\u00e1c th\u00f4ng th\u01b0\u1eddng c\u1ea3 hai b\u00ean \u0111\u1ec3 so s\u00e1nh.<\/p>\n

– C\u00e1c \u0111\u1ed9ng t\u00e1c c\u1ea3 chi tr\u00ean v\u00e0 chi d\u01b0\u1edbi.Kh\u00e1m c\u01a1 l\u1ef1c ng\u1ecdn chi v\u00e0 g\u1ed1c chi, so s\u00e1nh 2 b\u00ean c\u00e1c c\u01a1 t\u01b0\u01a1ng \u1ee9ng.<\/p>\n

– \u0110\u00e1nh gi\u00e1 c\u01a1 l\u1ef1c b\u1eb1ng c\u00e1ch t\u1ea1o ra c\u00e1c l\u1ef1c \u0111\u1ed1i kh\u00e1ng tr\u1ef1c ti\u1ebfp v\u1edbi t\u00ednh n\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a t\u1eebng nh\u00f3m c\u01a1 m\u1ed9t, v\u00e0 b\u1eb1ng c\u00e1ch xem b\u1ec7nh nh\u00e2n c\u00f3 th\u1ef1c hi\u1ec7n c\u00e1c \u0111\u1ed9ng t\u00e1c th\u00f4ng th\u01b0\u1eddng \u0111\u1ec3 ch\u1ed1ng l\u1ea1i \u1ea3nh h\u01b0\u1edfng c\u1ee7a tr\u1ecdng l\u1ef1c.<\/p>\n

2. C\u01a1 l\u1ef1c ng\u1ecdn chi<\/p>\n

– Chi tr\u00ean:\u0111\u1ec3 b\u1ec7nh nh\u00e2n n\u1eafm ch\u1eb7t hai ng\u00f3n tay c\u1ee7a ta trong l\u00f2ng b\u00e0n tay c\u1ee7a h\u1ecd, r\u1ed3i r\u00fat m\u1ea1nh hai ng\u00f3n tay ta ra \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u01a1 l\u1ef1c c\u00e1c ng\u00f3n tay c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

Nghi\u1ec7m ph\u00e1p g\u1ecdng k\u00ecm: khi b\u1ec7nh nh\u00e2n d\u00f9ng ng\u00f3n c\u00e1i l\u1ea7n l\u01b0\u1ee3t t\u1ea1o th\u00e0nh g\u1ecdng k\u00ecm v\u1edbi c\u00e1c ng\u00f3n tay kh\u00e1c, trong khi ta d\u00f9ng c\u00e1c ng\u00f3n tay t\u01b0\u01a1ng \u1ee9ng \u0111\u1eb7t trong g\u1ecdng k\u00ecm c\u1ed1 m\u1edf bung g\u1ecdng k\u00ecm ra. N\u1ebfu c\u01a1 l\u1ef1c b\u1ec7nh nh\u00e2n b\u00ecnh th\u01b0\u1eddng th\u00ec g\u1ecdng k\u00ecm b\u1ec7nh nh\u00e2n kh\u00f3 b\u1ecb bung ra.<\/p>\n

– Chi d\u01b0\u1edbi: BN c\u1ed1 g\u1eadp c\u00e1c ng\u00f3n ch\u00e2n v\u00e0o l\u00f2ng b\u00e0n ch\u00e2n, trong l\u00fac ta k\u00e9o ch\u00fang v\u1ec1 ph\u00eda ng\u01b0\u1ee3c l\u1ea1i.<\/p>\n

B\u1ec7nh nh\u00e2n c\u1ed1 g\u1ea5p c\u1ed5 ch\u00e2n \u0111\u1ec3 b\u00e0n ch\u00e2n v\u1ec1 ph\u00eda l\u00f2ng b\u00e0n ch\u00e2n (ho\u1eb7c g\u1ea5p v\u1ec1 ph\u00eda m\u1eb7t l\u01b0ng b\u00e0n ch\u00e2n), ta \u0111\u1ea9y (k\u00e9o) b\u00e0n ch\u00e2n v\u1ec1 h\u01b0\u1edbng ng\u01b0\u1ee3c l\u1ea1i.<\/p>\n

N\u1ebfu c\u01a1 l\u1ef1c b\u1ec7nh nh\u00e2n b\u00ecnh th\u01b0\u1eddng ta s\u1ebd kh\u00f3 l\u00e0m c\u00e1c \u0111\u1ed9ng t\u00e1c \u0111\u1ed1i kh\u00e1ng tr\u00ean, v\u00e0 ng\u01b0\u1ee3c l\u1ea1i s\u1ebd d\u1ec3 d\u00e0ng khi l\u00e0m c\u00e1c \u0111\u1ed9ng t\u00e1c \u0111\u1ed1i kh\u00e1ng v\u1edbi b\u1ec7nh nh\u00e2n<\/p>\n

3. C\u01a1 l\u1ef1c g\u1ed1c chi<\/p>\n

– Chi tr\u00ean:BN g\u1ea5p khu\u1ef7u tay (ho\u1eb7c du\u1ed7i kh\u1ee7yu tay), trong khi \u0111\u00f3 ta l\u00e0m \u0111\u1ed9ng t\u00e1c \u0111\u1ed1i kh\u00e1ng l\u1ea1i.<\/p>\n

+ Nghi\u1ec7m ph\u00e1p Barr\u00e9:Ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m ng\u1eeda, hai tay \u0111\u01b0a th\u1eb3ng t\u1ea1o v\u1edbi m\u1eb7t gi\u01b0\u1eddng m\u1ed9t g\u00f3c 60\u00b0, b\u00ean n\u00e0o y\u1ebfu (li\u1ec7t) s\u1ebd r\u01a1i xu\u1ed1ng tr\u01b0\u1edbc.<\/p>\n

Chi d\u01b0\u1edbi: b\u1ec7nh nh\u00e2n n\u1eb1m s\u1ea5p gi\u1eef hai c\u1eb3ng ch\u00e2n v\u1ec1 ph\u00eda \u0111\u00f9i, ta k\u00e9o ng\u01b0\u1ee3c l\u1ea1i c\u1eb3ng ch\u00e2n th\u1eb3ng ra (c\u01a1 g\u1ea5p). Ho\u1eb7c BN n\u1eb1m s\u1ea5p du\u1ed7i c\u1ed1 hai ch\u00e2n s\u00e1t m\u1eb7t gi\u01b0\u1eddng, trong khi ta c\u1ed1 \u0111\u1ea9y c\u1eb3ng ch\u00e2n h\u1ecd \u00e1p v\u00e0o \u0111\u00f9i<\/p>\n

Nghi\u1ec7m ph\u00e1p Barr\u00e9 ch\u00e2n: ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m s\u1ea5p, \u0111\u1ec3 c\u1eb3ng ch\u00e2n ng\u01b0\u1eddi b\u1ec7nh 45\u00b0 v\u1edbi m\u1eb7t gi\u01b0\u1eddng. B\u00ean n\u00e0o y\u1ebfu li\u1ec7t s\u1ebd r\u01a1i xu\u1ed1ng tr\u01b0\u1edbc.<\/p>\n

Nghi\u1ec7m ph\u00e1p Mingazzini: ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m ng\u1eeda, hai ch\u00e2n \u0111\u01b0a l\u00ean, c\u1eb3ng ch\u00e2n th\u1eb3ng g\u00f3c v\u1edbi \u0111\u00f9i, \u0111\u00f9i th\u1eb3ng g\u00f3c v\u1edbi m\u1eb7t gi\u01b0\u1eddng. B\u00ean n\u00e0o y\u1ebfu li\u1ec7t s\u1ebd r\u01a1i xu\u1ed1ng tr\u01b0\u1edbc.<\/p>\n

\u0110\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3: Vi\u1ec7c th\u0103m kh\u00e1m v\u1eadn \u0111\u1ed9ng v\u00e0 c\u01a1 l\u1ef1c c\u1ee7a t\u1eebng \u0111o\u1ea1n cho ph\u00e9p ph\u00e1t hi\u1ec7n t\u00ecnh tr\u1ea1ng li\u1ec7t, kh\u00f4ng nh\u1eefng v\u1ec1 c\u01b0\u1eddng \u0111\u1ed9 li\u1ec7t m\u00e0 c\u00f2n v\u1ec1 \u0111\u1ecba \u0111i\u1ec3m li\u1ec7t.<\/p>\n

a. C\u01b0\u1eddng \u0111\u1ed9: C\u00f3 th\u1ec3 li\u1ec7t ho\u00e0n to\u00e0n, hay ch\u1ec9 li\u1ec7t nh\u1eb9. H\u00e3y so s\u00e1nh hai b\u00ean \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 c\u1ea7n lo\u1ea1i tr\u1eeb \u0111\u1ed9ng t\u00e1c y\u1ebfu do teo c\u01a1 ho\u1eb7c b\u1ec7nh kh\u1edbp l\u00e0m h\u1ea1n ch\u1ebf c\u1eed \u0111\u1ed9ng.<\/p>\n

b. X\u00e1c \u0111\u1ecbnh \u0111\u1ecba \u0111i\u1ec3m li\u1ec7t: T\u00f9y theo t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh \u1edf \u0111\u00e2u m\u00e0 li\u1ec7t c\u00f3 th\u1ec3 khu tr\u00fa hay lan t\u1ecfa. Do \u0111\u00f3 x\u00e1c \u0111\u1ecbnh \u0111\u1ecba \u0111i\u1ec3m li\u1ec7t l\u00e0 c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh. V\u00ed d\u1ee5:<\/p>\n

– Th\u00e2n th\u1ea7n kinh: khi li\u1ec7t v\u1eadn \u0111\u1ed9ng m\u1ed9t nh\u00f3m c\u01a1 chi ph\u1ed1i b\u1edfi m\u1ed9t d\u00e2y th\u1ea7n kinh s\u1ecd n\u00e3o hay TK t\u1ee7y, ta c\u00f3 th\u1ec3 cho l\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ngo\u1ea1i bi\u00ean. Nh\u01b0 tr\u01b0\u1eddng h\u1ee3p li\u1ec7t m\u1eb7t ngo\u1ea1i bi\u00ean, li\u1ec7t TK quay\u2026\u2026<\/p>\n

– R\u1ec5 th\u1ea7n kinh: khi li\u1ec7t v\u1eadn \u0111\u1ed9ng m\u1ed9t nh\u00f3m c\u01a1 \u1edf v\u00f9ng chi ph\u1ed1i b\u1edfi m\u1ed9t hay nhi\u1ec1u r\u1ec5 t\u1ee7y tr\u01b0\u1edbc, \u0111\u00e2y c\u00f3 th\u1ec3 l\u00e0 t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c \u1edf r\u1ec5 ho\u1eb7c th\u1ea7n kinh t\u1ee7y, ho\u1eb7c \u1edf s\u1eebng tr\u01b0\u1edbc t\u1ee7y s\u1ed1ng. Th\u00ed d\u1ee5 \u1edf chi tr\u00ean khi b\u1ecb t\u1ed5n th\u01b0\u01a1ng C5-C6 c\u00e1c c\u01a1\u0111en ta, nh\u1ecb \u0111\u1ea7u, c\u01a1 c\u00e1nh tay tr\u01b0\u1edbc v\u00e0 s\u1ea5p d\u00e0i s\u1ebd kh\u00f4ng v\u1eadn \u0111\u1ed9ng \u0111\u01b0\u1ee3c.<\/p>\n

– Li\u1ec7t m\u1ed9t chi: th\u01b0\u1eddng do t\u1ed5n th\u01b0\u01a1ng r\u1ec5 t\u1ee7y, s\u1eebng tr\u01b0\u1edbc t\u1ee7y s\u1ed1ng, \u00edt khi t\u1ed5n th\u01b0\u01a1ng v\u00f9ng g. h\u1ea1n \u1edf v\u1ecf n\u00e3o.<\/p>\n

– Li\u1ec7t n\u1eeda th\u00e2n: do t\u1ed5n th\u01b0\u01a1ng v\u1ecf n\u00e3o \u0111\u1ed1i di\u1ec7n v\u1edbi b\u00ean li\u1ec7t.<\/p>\n

– Li\u1ec7t hai chi d\u01b0\u1edbi: th\u01b0\u1eddng do t\u1ed5n th\u01b0\u01a1ng \u1edf t\u1ee7y, ho\u1eb7c th\u01b0\u1eddng do t\u1ed5n th\u01b0\u01a1ng hai b\u00ean r\u1ec5 t\u1ee7y hay do t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ngo\u1ea1i bi\u00ean, r\u1ea5t \u00edt khi do t\u1ed5n th\u01b0\u01a1ng c\u1ea3 hai b\u00ean b\u00e1n c\u1ea7u n\u00e3o.<\/p>\n

– Li\u1ec7t ng\u1ecdn chi t\u1ed5n th\u01b0\u01a1ng b\u00f3 th\u00e1p ho\u1eb7c d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean.<\/p>\n

– Li\u1ec7t g\u1ed1c chi: t\u1ed5n th\u01b0\u01a1ng r\u1ec5 ho\u1eb7c b\u1ec7nh c\u1ee7a c\u01a1.<\/p>\n

– Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p li\u1ec7t c\u1ea7n x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n l\u00e0 t\u1ed5n th\u01b0\u01a1ng \u1edf trung \u01b0\u01a1ng hay \u1edf \u0111\u1ecba ph\u01b0\u01a1ng.<\/p>\n

– Trong tr\u01b0\u1eddng h\u1ee3p li\u1ec7t n\u1eeda th\u00e2n ch\u1eafc ch\u1eafn do t\u1ed5n th\u01b0\u01a1ng \u1edf th\u1ea7n kinh trung \u01b0\u01a1ng, c\u00f2n li\u1ec7t do t\u1ed5n th\u01b0\u01a1ng th\u00e2n hay r\u1ec5 th\u1ea7n kinh l\u00e0 do t\u1ed5n th\u01b0\u01a1ng ngo\u1ea1i bi\u00ean.<\/p>\n

– Li\u1ec7t ngo\u1ea1i bi\u00ean th\u01b0\u1eddng l\u00e0 li\u1ec7t m\u1ec1m, ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng gi\u1ea3m, c\u00f3 teo c\u01a1 v\u00e0 ph\u1ea3n \u1ee9ng tho\u00e1i h\u00f3a \u0111i\u1ec7n.<\/p>\n

– Li\u1ec7t trung \u01b0\u01a1ng c\u00f3 th\u1ec3 c\u00f3 li\u1ec7t m\u1ec1m nh\u01b0ng v\u1ec1 sau th\u01b0\u1eddng chuy\u1ec3n sang li\u1ec7t c\u1ee9ng, ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng t\u0103ng v\u00e0 th\u01b0\u1eddng k\u00e8m theo d\u1ea5u Babinsky.<\/p>\n

II. Kh\u00e1m tr\u01b0\u01a1ng l\u1ef1c c\u01a1<\/p>\n

Theo thuy\u1ebft c\u1ed5 \u0111i\u1ec3n ng\u01b0\u1eddi ta cho r\u1eb1ng 2 ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng v\u00e0 tr\u01b0\u01a1ng l\u1ef1c c\u01a1 kh\u00e1c nhau, v\u1eadn \u0111\u1ed9ng l\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c \u0111\u1ed9ng t\u00e1c c\u00f2n tr\u01b0\u01a1ng l\u1ef1c c\u01a1 l\u00e0 tham gia duy tr\u00ec t\u01b0 th\u1ebf v\u00e0 d\u00e1ng b\u1ed9. Theo quan \u0111i\u1ec3m hi\u1ec7n nay hai ch\u1ee9c n\u0103ng n\u00e0y kh\u00f4ng th\u1ec3 t\u00e1ch r\u1eddi nhau, v\u00ec hai ch\u1ee9c anwng n\u00e0y \u0111\u1ec1u \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf c\u01a1 v\u00e2n.<\/p>\n

* M\u1ed9t s\u1ed1 c\u00e1ch kh\u00e1m<\/p>\n

Th\u01b0\u1eddng kh\u00e1m \u1edf c\u00e1c chi, ng\u01b0\u1eddi b\u1ec7nh \u1edf c\u00e1c t\u01b0 th\u1ebf th\u1ee5c \u0111\u1ed9ng kh\u00f4ng l\u00ean g\u00e2n, ho\u1eb7c b\u1ea3o BN l\u00e0m c\u00e1c \u0111\u1ed9ng t\u00e1c ch\u1ee7 \u0111\u1ed9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1<\/p>\n

Chi tr\u00ean: ng\u01b0\u1eddi b\u1ec7nh v\u00f2ng tay qua c\u1ed5, \u0111\u1eb7t l\u00f2ng b\u00e0n tay v\u00e0o v\u00f9ng x\u01b0\u01a1ng b\u1ea3 vai c\u00f9ng b\u00ean<\/p>\n

Th\u1ea7y thu\u1ed1c c\u1ea7m c\u1ed5 tay, c\u1ed5 ch\u00e2n ng\u01b0\u1eddi b\u1ec7nh l\u1eafc m\u1ea1nh \u0111\u1ec3 t\u00ecm \u0111\u1ed9 ve v\u1ea9y c\u1ee7a b\u00e0n ch\u00e2n, ho\u1eb7c b\u00e0n tay ng\u01b0\u1eddi b\u1ec7nh. Ho\u1eb7c l\u1eafc c\u1ea3 th\u00e2n m\u00ecnh b\u1ec7nh nh\u00e2n v\u1ec1 ph\u1ea3i r\u1ed3i v\u1ec1 tr\u00e1i \u0111\u1ec3 xem bi\u00ean \u0111\u1ed9 vung tay c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

Chi d\u01b0\u1edbi: g\u00f3t ch\u00e2n \u0111\u1eb7t v\u00e0o m\u00f4ng c\u00f9ng b\u00ean<\/p>\n

\u0110\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3: Ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng c\u00f3 1 s\u1ef1 \u0111\u1ec1 kh\u00e1ng nh\u1ecf khi l\u00e0m nh\u1eefng \u0111\u1ed9ng t\u00e1c th\u1ee5 \u0111\u1ed9ng tr\u00ean<\/p>\n

Khi \u0111\u1ec1 kh\u00e1ng t\u0103ng: c\u00e1c \u0111\u1ed9ng t\u00e1c tr\u00ean b\u1ecb h\u1ea1n ch\u1ebf, ta g\u1ecdi l\u00e0 t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1. L\u00fac \u0111\u00f3 c\u00e1c c\u01a1 th\u01b0\u1eddng r\u1eafn h\u01a1n b\u00ecnh th\u01b0\u1eddng, m\u1eb7c d\u00f9 \u0111ang ngh\u1ec9 ng\u01a1i<\/p>\n

Khi \u0111\u1ec1 kh\u00e1ng gi\u1ea3m: l\u00fac \u0111\u00f3 c\u00e1c c\u01a1 th\u01b0\u1eddng nh\u1ebdo. B\u00e0n tay c\u00f3 th\u1ec3 v\u1edbi t\u1edbi v\u00f9ng x\u01b0\u01a1ng b\u1ea3 vai c\u00f9ng b\u00ean, ho\u1eb7c g\u00f3t ch\u00e2n ch\u1ea1m m\u00f4ng c\u0169ng b\u00ean.<\/p>\n

1. Tr\u01b0\u01a1ng l\u1ef1c c\u01a1 t\u0103ng: c\u00f3 th\u1ec3 k\u00e8m theo ho\u1eb7c kh\u00f4ng k\u00e8m theo li\u1ec7t<\/p>\n

Tr\u01b0\u01a1ng l\u1ef1c c\u01a1 t\u0103ng c\u00f3 k\u00e8m theo li\u1ec7t: l\u00e0 li\u1ec7t c\u1ee9ng, l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh trung \u01b0\u01a1ng, c\u00f3 t\u1ed5n th\u01b0\u01a1ng b\u00f3 th\u00e1p. Tr\u01b0\u1eddng h\u1ee3p n\u00e0y g\u1ecdi l\u00e0 co c\u1ee9ng th\u00e1p, \u0111i\u1ec3m h\u00ecnh nh\u1ea5t l\u00e0 li\u1ec7t c\u1ee9ng n\u1eeda ng\u01b0\u1eddi. Lo\u1ea1i t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1 n\u00e0y g\u1ecdi l\u00e0 t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1 do th\u00e1p:<\/p>\n

Tr\u01b0\u01a1ng l\u1ef1c c\u01a1 t\u0103ng l\u00ean khi l\u00e0m \u0111\u1ed9ng t\u00e1c c\u1ed1 \u00fd<\/p>\n

T\u0103ng r\u00f5 \u1edf c\u00e1c c\u01a1 g\u1ea5p chi tr\u00ean v\u00e0 nh\u00f3m c\u01a1 du\u1ed7i chi d\u01b0\u1edbi<\/p>\n

T\u0103ng ki\u1ec3u \u0111\u00e0n h\u1ed3i, chi \u0111ang \u1edf t\u01b0 th\u1ebf g\u1ea5p k\u00e9o du\u1ed7i ra, th\u00f4i k\u00e9o \u0111o\u1ea1n chi s\u1ebd g\u1ea5p l\u1ea1i v\u1ecb tr\u00ed c\u0169<\/p>\n

Tr\u01b0\u01a1ng l\u1ef1c c\u01a1 t\u0103ng kh\u00f4ng k\u00e8m theo li\u1ec7t: l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng ngo\u1ea1i th\u00e1p, \u0111\u00f3 l\u00e0 co c\u1ee9ng ngo\u1ea1i th\u00e1p m\u00e0 ti\u00eau bi\u1ec3u l\u00e0 b\u1ec7nh Parkinson. \u0110\u00e2y l\u00e0 t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1 ngo\u1ea1i th\u00e1p:<\/p>\n

T\u0103ng r\u00f5 \u1edf c\u00e1c c\u01a1 \u0111\u1ea3m tr\u00e1ch c\u00e1c \u0111\u1ed9ng t\u00e1c t\u1ef1 \u0111\u1ed9ng: n\u00e9t m\u1eb7t, c\u01a1 gi\u1eef t\u01b0 th\u1ebf \u0111i, \u0111\u1ee9ng<\/p>\n

G\u1ed1c chi t\u0103ng h\u01a1n ng\u1ecdn chi<\/p>\n

T\u0103ng tr\u01b0\u01a1ng l\u1ef1c t\u1ea1o h\u00ecnh: gi\u1eef nguy\u00ean tr\u1ea1ng th\u00e1i v\u1ecb tr\u00ed t\u01b0 th\u1ebf m\u1edbi khi ta l\u00e0m \u0111\u1ed9ng t\u00e1c \u1edf \u0111o\u1ea1n chi \u0111\u00f3<\/p>\n

Khi g\u1ea5p ho\u1eb7c du\u1ed7i c\u00e1c kh\u00fac chi ta c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng b\u00e1nh xe r\u0103ng c\u01b0a<\/p>\n

2. Tr\u01b0\u01a1ng l\u1ef1c c\u01a1 gi\u1ea3m: c\u00f3 2 lo\u1ea1i<\/p>\n

Tr\u01b0\u01a1ng l\u1ef1c c\u01a1 gi\u1ea3m k\u00e8m theo li\u1ec7t: g\u1ecdi l\u00e0 li\u1ec7t m\u1ec1m. \u0110\u00f3 l\u00e0 t\u1ea5t c\u1ea3 tr\u01b0\u1eddng h\u1ee3p li\u1ec7t ngo\u1ea1i bi\u00ean, v\u00e0 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p li\u1ec7t trung \u01b0\u01a1ng giai \u0111o\u1ea1n \u0111\u1ea7u<\/p>\n

Tr\u01b0\u01a1ng l\u1ef1c c\u01a1 gi\u1ea3m kh\u00f4ng k\u00e8m theo li\u1ec7t: \u0111\u1eb7c bi\u1ec7t trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng c\u00e1c \u0111\u01b0\u1eddng c\u1ea3m gi\u00e1c s\u00e2u: t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh c\u1ea3m gi\u00e1c, c\u00e1c r\u1ec5 sau, c\u00e1c s\u1eebng sau t\u1ee7y s\u1ed1ng (Tabes). C\u0169ng g\u1eb7p trong c\u00e1c h\u1ed9i ch\u1ee9ng ti\u1ec3u n\u00e3o. T\u1ed5n th\u01b0\u01a1ng ti\u1ec1n \u0111\u00ecnh ngo\u1ea1i bi\u00ean<\/p>\n

III. Kh\u00e1m ph\u1ed1i h\u1ee3p \u0111\u1ed9ng t\u00e1c v\u00e0 th\u0103ng b\u1eb1ng<\/p>\n

B\u00ecnh th\u01b0\u1eddng d\u00f9 c\u00e1c \u0111\u1ed9ng t\u00e1c \u0111\u01a1n gi\u1ea3n c\u0169ng ph\u1ea3i c\u00f3 qu\u00e1 tr\u00ecnh ph\u00e2n t\u00edch v\u00e0 t\u1ed5ng h\u1ee3p c\u00e1c \u0111\u1ed9ng t\u00e1c nh\u1ecf v\u00e0 y\u1ebfu t\u1ed1 t\u00e2m l\u00fd \u0111\u1ec3 c\u00f3 s\u1ef1 ph\u1ed1i h\u1ee3p v\u00e0 gi\u1eef th\u0103ng b\u1eb1ng. S\u1ef1 m\u1ea5t th\u0103ng b\u1eb1ng v\u00e0 ph\u1ed1i h\u1ee3p \u0111\u1ed9ng t\u00e1c g\u1ecdi l\u00e0 lo\u1ea1ng cho\u1ea1ng (ataxie) \u0111\u1eb7c bi\u1ec7t th\u01b0\u1eddng g\u1eb7p trong nh\u1eefng r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c s\u00e2u b\u1ec7nh tabes, h\u1ed9i ch\u1ee9ng ti\u1ec3u n\u00e3o, h\u1ed9i ch\u1ee9ng ti\u1ec1n \u0111\u00ecnh<\/p>\n

Nh\u1eefng nghi\u1ec7m ph\u00e1p ph\u00e1t hi\u1ec7n lo\u1ea1ng cho\u1ea1ng:<\/p>\n

Ng\u00f3n tay ch\u1ec9 m\u0169i: b\u1ea3o b\u1ec7nh nh\u00e2n dang tay ra, d\u00f9ng ng\u00f3n tr\u1ecf ch\u1ec9 \u0111\u00fang v\u00e0o m\u0169i. C\u00f3 3 kh\u1ea3 n\u0103ng:<\/p>\n

Ng\u01b0\u1eddi b\u1ec7nh ch\u1ec9 \u0111\u00fang, kh\u00f4ng run: b\u00ecnh th\u01b0\u1eddng<\/p>\n

Ch\u1ec9 qu\u00e1 m\u1ee9c: qu\u00e1 t\u1ea7m. G\u1eb7p trong t\u1ed5n th\u01b0\u01a1ng ti\u1ec3u n\u00e3o<\/p>\n

Ch\u1ec9 kh\u00f4ng \u0111\u00fang \u0111\u00edch: ngay l\u00fac l\u00e0m \u0111\u1ed9ng t\u00e1c, ng\u00f3n tay run r\u1ea9y, h\u01b0\u1edbng ch\u1ec9 kh\u00f4ng \u0111\u00fang: r\u1ed1i t\u1ea7m. G\u1eb7p trong t\u1ed5n th\u01b0\u01a1ng c\u1ea3m gi\u00e1c s\u00e2u v\u00e0 b\u1ec7nh tabes.<\/p>\n

G\u00f3t ch\u00e2n \u0111\u1ea7u g\u1ed1i: b\u1ec7nh nh\u00e2n n\u1eb1m, hai ch\u00e2n du\u1ed7i \u0111\u01b0a g\u00f3t ch\u00e2n 1 b\u00ean l\u00ean cao r\u1ed3i \u0111\u1eb7t \u0111\u00fang v\u00e0o x\u01b0\u01a1ng b\u00e1nh ch\u00e8, sau \u0111\u00f3 \u0111\u01b0a d\u1ecdc g\u00f3t ch\u00e2n theo x\u01b0\u01a1ng ch\u00e0y. Trong t\u1ed5n th\u01b0\u01a1ng ti\u1ec3u n\u00e3o, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1eb7t \u0111\u00fang h\u01b0\u1edbng nh\u01b0ng khi \u0111\u01b0a g\u00f3t ch\u00e2n d\u1ecdc x\u01b0\u01a1ng ch\u00e0y th\u00ec b\u1ed9c l\u1ed9 r\u00f5 th\u1ea5t \u0111i\u1ec1u, g\u00f3t ch\u00e2n tr\u1eadt ra ngo\u00e0i hai b\u00ean c\u1eb3ng ch\u00e2n (khi nh\u1eafm m\u1eaft l\u00e0m nghi\u1ec7m ph\u00e1p tr\u00ean, r\u1ed1i lo\u1ea1n kh\u00f4ng t\u0103ng th\u00eam). Trong th\u1ea5t \u0111i\u1ec1u do r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c s\u00e2u c\u1ee7a b\u1ec7nh tabes, b\u1ec7nh nh\u00e2n \u0111\u01b0a g\u00f3t ch\u00e2n qu\u00e1 m\u1ee9c c\u1ea7n thi\u1ebft r\u1ed3i m\u1edbi \u0111\u1eb7t ch\u00e2n xu\u1ed1ng x\u01b0\u01a1ng b\u00e1nh ch\u00e8, \u0111\u01b0a d\u1ecdc x\u01b0\u01a1ng ch\u00e0y s\u1ebd ch\u1ec7ch h\u01b0\u1edbng (nh\u1eafm m\u1eaft khi l\u00e0m nghi\u1ec7m ph\u00e1p c\u00e1c \u0111\u1ed9ng t\u00e1c s\u1ebd b\u1ed9c l\u1ed9 r\u1ed1i lo\u1ea1n h\u01a1n)<\/p>\n

L\u1eadt \u00fap b\u00e0n tay li\u1ec7n ti\u1ebfp: b\u00ecnh th\u01b0\u1eddng nh\u1ecbp nh\u00e0ng, nhanh nh\u1eb9n. Khi th\u1ef1c hi\u1ec7n \u0111\u1ed9ng t\u00e1c kh\u00f3 kh\u0103n, ng\u01b0\u1ee3ng ngh\u1ecbu th\u00ec g\u1ecdi l\u00e0 m\u1ea5t linh \u0111\u1ed9ng, th\u01b0\u1eddng g\u1eb7p trong h\u1ed9i ch\u1ee9ng ti\u1ec3u n\u00e3o (tri\u1ec7u ch\u1ee9ng ch\u1ec9 c\u00f3 gi\u00e1 tr\u1ecb khi kh\u00f4ng c\u00f3 li\u1ec7t v\u00e0 kh\u00f4ng c\u00f3 t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1)<\/p>\n

D\u1ea5u hi\u1ec7u Romberg: ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ee9ng ch\u1ee5m ch\u00e2n, nh\u1eafm m\u1eaft, 2 tay \u0111\u01b0a ra ph\u00eda tr\u01b0\u1edbc. Romberg (+) ng\u01b0\u1eddi b\u1ec7nh s\u1ebd nghi\u00eang ng\u00e3, chao \u0111\u1ea3o r\u1ed3i ng\u00e3<\/p>\n

Tabes: ng\u00e3 b\u1ea5t c\u1ee9 h\u01b0\u1edbng n\u00e0o<\/p>\n

H\u1ed9i ch\u1ee9ng ti\u1ec1n \u0111\u00ecnh: lu\u00f4n ng\u00e3 v\u1ec1 m\u1ed9t h\u01b0\u1edbng, h\u01b0\u1edbng n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o t\u01b0 th\u1ebf \u0111\u1ea7u ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

IV. V\u1eadn \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng<\/p>\n

C\u00f3 nhi\u1ec1u lo\u1ea1i v\u1eadn \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng kh\u00f4ng t\u1ef1 ch\u1ee7<\/p>\n

1. Nguy\u00ean t\u1eafc kh\u00e1m<\/p>\n

Quan s\u00e1t b\u1ec7nh nh\u00e2n l\u00fac ngh\u1ec9, ho\u1eb7c k\u00edch th\u00edch b\u1ec7nh nh\u00e2n b\u1eb1ng b\u00faa ph\u1ea3n x\u1ea1 hay kim ch\u00e2m, nh\u1ea5t l\u00e0 nh\u1eefng lo\u1ea1i v\u1eadn \u0111\u1ed9ng c\u00f3 bi\u00ean \u0111\u1ed9 th\u1ea5p.<\/p>\n

Ghi nh\u1eadn t\u00ednh ch\u1ea5t v\u1eadn \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng: \u0111\u1ecba \u0111i\u1ec3m, nh\u1ecbp \u0111i\u1ec7u, c\u01b0\u1eddng \u0111\u1ed9, th\u1eddi gian xu\u1ea5t hi\u1ec7n v\u00e0 \u1ea3nh h\u01b0\u1edfng c\u1ee7a b\u00ean ngo\u00e0i.<\/p>\n

C\u00e1c \u0111\u1ed9ng t\u00e1c b\u1ea5t th\u01b0\u1eddng ch\u1ee7 y\u1ebfu:<\/p>\n

Run: L\u00e0 nh\u1eefng c\u1eed \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng c\u00f3 bi\u00ean \u0111\u1ed9 \u0111\u1ec1u, \u1edf \u0111\u1ea7u chi. Nhi\u1ec1u ki\u1ec3u run nh\u01b0 b\u1ec7nh Parkinson, b\u1ec7nh ti\u1ec3u n\u00e3o, Basedow, u\u1ed1ng r\u01b0\u1ee3u, tu\u1ed5i gi\u00e0.<\/p>\n

Co gi\u1eadt: hi\u1ec7n t\u01b0\u1ee3ng gi\u1eadt c\u01a1 khu tr\u00fa hay to\u00e0n th\u1ec3, bi\u00ean \u0111\u1ed9 l\u1edbn, t\u1ea7n s\u1ed1 l\u1edbn, t\u1ea7n s\u1ed1 th\u1ea5p. Th\u01b0\u1eddng g\u1eb7p trong b\u1ec7nh \u0111\u1ed9ng kinh, u\u1ed1n v\u00e1n, ure m\u00e1u cao, s\u1ea3n gi\u1eadt, s\u1ed1t cao \u1edf tr\u1ebb em.<\/p>\n

M\u00faa nhanh: l\u00e0 nh\u1eefng c\u1eed \u0111\u1ed9ng h\u1ed7n \u0111\u1ed9n, v\u00f4 ngh\u0129a. Bi\u00ean \u0111\u1ed9 l\u1edbn, nhanh. \u0110i\u1ec3n h\u00ecnh l\u00e0 c\u01a1n m\u00faa nhanh Sydenham.<\/p>\n

M\u00faa v\u1eddn: c\u1eed \u0111\u1ed9ng ch\u1eadm, u\u1ed1ng l\u01b0\u1ee3n, th\u01b0\u1eddng khu tr\u00fa \u1edf ng\u1ecdn chi tr\u00ean.<\/p>\n

2. Nghi\u00ean c\u1ee9u m\u1ed9t v\u00e0i d\u00e1ng \u0111i<\/p>\n

D\u00e1ng \u0111i v\u00f2ng ki\u1ec1ng (ki\u1ec3u ph\u00e1t c\u1ecf): ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng g\u1eadp \u0111\u00f9i l\u1ea1i \u0111\u01b0\u1ee3c (v\u00ec li\u1ec7t c\u1ee9ng \u1edf t\u01b0 th\u1ebf du\u1ed7i) n\u00ean \u0111i v\u00e1t th\u00e0nh n\u1eefa v\u00f2ng nh\u01b0 ph\u00e1t c\u1ecf. Trong tr\u01b0\u1eddng h\u1ee3p li\u1ec7t n\u1eeda th\u00e2n v\u00e0 li\u1ec7t c\u1ee9ng, n\u1ebfu co c\u1ee9ng trung b\u00ecnh th\u00ec d\u00e1ng \u0111i ki\u1ec3u qu\u00e9t \u0111\u1ea5t.<\/p>\n

Trong li\u1ec7t c\u1ee9ng hai chi d\u01b0\u1edbi. Ng\u01b0\u1eddi b\u1ec7nh \u0111i \u0111\u01b0\u1ee3c v\u00e0 2 \u0111\u00f9i s\u00e1t v\u00e0o nhau, \u0111\u1ea7u g\u1ed1i va v\u00e0o nhau, b\u00e0n ch\u00e2n kh\u00f3 nh\u1ea5c l\u00ean. Trong tr\u01b0\u1eddng h\u1ee3p co c\u1ee9ng qu\u00e1 ph\u1ea3i d\u00f9ng n\u1ea1ng, 2 ch\u00e2n l\u1ee7ng l\u1eb3ng nh\u01b0 qu\u1ea3 l\u1eafc \u0111\u1ed3ng h\u1ed3.<\/p>\n

D\u00e1ng \u0111i ch\u1eadm, 2 tay d\u00e1n s\u00e1t v\u00e0o th\u00e2n, kh\u00f4ng c\u00f3 \u0111\u1ed9 vung v\u1ea9y tay trong b\u1ec7nh Parkinson.<\/p>\n

V. C\u00e1c b\u1eadc c\u01a1 l\u1ef1c<\/p>\n

\u0110\u1ed9 0: kh\u00f4ng c\u00f3 co c\u01a1<\/p>\n

\u0110\u1ed9 1: co c\u01a1 kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u1ed9ng t\u00e1c<\/p>\n

\u0110\u1ed9 2: co c\u01a1 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u1ed9ng t\u00e1c nh\u01b0ng kh\u00f4ng th\u1eafng l\u1ef1c tr\u1ecdng tr\u01b0\u1eddng<\/p>\n

\u0110\u1ed9 3: co c\u01a1 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u1ed9ng t\u00e1c nh\u01b0ng th\u1eafng l\u1ef1c tr\u1ecdng tr\u01b0\u1eddng, kh\u00f4ng th\u1eafng l\u1ef1c c\u1ea3n<\/p>\n

\u0110\u1ed9 4: th\u1eafng \u0111\u01b0\u1ee3c l\u1ef1c c\u1ea3n nh\u01b0ng y\u1ebfu<\/p>\n

\u0110\u1ed9 5: c\u01a1 ho\u00e0n to\u00e0n b\u00ecnh th\u01b0\u1eddng<\/p>\n

C\u00e2u 18: Tr\u00ecnh b\u00e0y kh\u00e1m ph\u1ea3n x\u1ea1?<\/p>\n

Ho\u1ea1t \u0111\u1ed9ng c\u01a1 b\u1ea3n c\u1ee7a th\u1ea7n kinh l\u00e0 ho\u1ea1t \u0111\u1ed9ng ph\u1ea3n x\u1ea1, l\u00e0 s\u1ef1 \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ed9 m\u00e1y th\u1ea7n kinh \u0111\u1ed1i v\u1edbi nh\u1eefng k\u00edch th\u00edch b\u00ean ngo\u00e0i ho\u1eb7c b\u00ean trong th\u00f4ng qua th\u1ea7n kinh trung \u01b0\u01a1ng. C\u00f3 nhi\u1ec1u lo\u1ea1i ph\u1ea3n x\u1ea1. Ph\u1ea3n x\u1ea1 qua t\u1ee7y nh\u01b0 ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng, da, ni\u00eam m\u1ea1c. Ph\u1ea3n x\u1ea1 c\u00f3 \u0111i\u1ec1u ki\u1ec7n \u0111i qua n\u00e3o nh\u01b0 ph\u1ea3n x\u1ea1 Paplop. \u0110\u00e2y ch\u00fang ta ch\u1ec9 nghi\u00ean c\u1ee9u ph\u1ea3n x\u1ea1 qua t\u1ee7y, c\u00e1ch kh\u00e1m v\u00e0 \u0111\u00e1nh gi\u00e1 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n

I. M\u1ee5c \u0111\u00edch v\u00e0 \u00fd ngh\u0129a c\u1ee7a kh\u00e1m ph\u1ea3n x\u1ea1.<\/p>\n

– Kh\u00e1m ph\u1ea3n x\u1ea1 c\u00f3 \u00fd ngh\u0129a quan tr\u1ecdng trong vi\u1ec7c kh\u00e1m th\u1ea7n kinh v\u00ec:<\/p>\n

\u00fc C\u00f3 r\u1ed1i lo\u1ea1n ph\u1ea3n x\u1ea1, ch\u1eafc ch\u1eafn l\u00e0 c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1ef1c th\u1ec3 \u1edf b\u1ed9 m\u00e1y th\u1ea7n kinh.<\/p>\n

\u00fc \u0110\u1ed1i chi\u1ebfu c\u00e1c khoanh ph\u1ea3n x\u1ea1 v\u1edbi v\u1ecb tr\u00ed khu tr\u00fa c\u1ee7a ph\u1ea3n x\u1ea1 b\u1ecb r\u1ed1i lo\u1ea1n, ta c\u00f3 th\u1ec3 bi\u1ebft \u0111\u01b0\u1ee3c \u0111\u1ecba \u0111i\u1ec3m c\u1ee7a t\u1ed5n th\u01b0\u01a1ng.<\/p>\n

– N\u01a1i ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng:<\/p>\n

\u00fc M\u1ed7i ph\u1ea3n x\u1ea1 \u0111\u1ec1u c\u00f3 m\u1ed9t \u0111\u1ecba \u0111i\u1ec3m g\u00e2y ph\u1ea3n x\u1ea1 c\u1ed1 \u0111\u1ecbnh v\u00e0 h\u1ea7u h\u1ebft \u0111\u1ed1i x\u1ee9ng hai b\u00ean.<\/p>\n

\u00fc \u0110\u1ed1i v\u1edbi m\u1ed7i ph\u1ea3n x\u1ea1 hai b\u00ean s\u1ebd tr\u1ea3 l\u1eddi \u0111\u1ec1u nhau, khi c\u01b0\u1eddng \u0111\u1ed9 k\u00edch th\u00edch b\u1eb1ng nhau.<\/p>\n

\u00fc M\u1ed7i ph\u1ea3n x\u1ea1 t\u01b0\u01a1ng \u1ee9ng v\u1edbi 3 khoanh t\u1ee7y. Theo quy \u01b0\u1edbc ta ch\u1ec9 d\u00f9ng khoanh gi\u1eefa \u0111\u1ec3 ch\u1ec9 khoanh t\u1ee7y \u0111\u00f3. Th\u00ed d\u1ee5 ph\u1ea3n x\u1ea1 b\u00e1nh ch\u00e8 t\u01b0\u01a1ng \u1ee9ng \u1edf t\u1ee7y l\u01b0ng L3, thu\u1ed9ckhoanh t\u1ee7y L2 L3 L4.<\/p>\n

II. C\u00e1c lo\u1ea1i ph\u1ea3n x\u1ea1 th\u00f4ng th\u01b0\u1eddng<\/p>\n

1. Ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng<\/p>\n

a. Nguy\u00ean t\u1eafc chung:<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh \u1edf t\u01b0 th\u1ebf tho\u1ea3i m\u00e1i. D\u00f9ng b\u00faa ph\u1ea3n x\u1ea1 c\u00f3 tr\u1ecdng l\u01b0\u1ee3ng quy \u0111\u1ecbnh g\u00f5 \u0111\u00fang v\u00e0o g\u00e2n c\u01a1 v\u00e0 m\u00e0ng x\u01b0\u01a1ng, kh\u00f4ng g\u00f5 v\u00e0o th\u00e2n c\u01a1.<\/p>\n

– Kh\u00e1m hai b\u00ean \u0111\u1ec3 so s\u00e1nh, t\u1eeb tr\u00ean xu\u1ed1ng d\u01b0\u1edbi theo t\u00ecnh t\u1ef1 nh\u1ea5t \u0111\u1ecbnh.<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh m\u1ea5t ph\u1ea3n x\u1ea1, ph\u1ea3i ch\u1eafc ch\u1eafn ng\u01b0\u1eddi \u0111\u00f3 kh\u00f4ng l\u00ean g\u00e2n t\u1ee9c l\u00e0 kh\u00f4ng co c\u01a1 ch\u1ee7 \u0111\u1ed9ng th\u00ec tri\u1ec7u ch\u1ee9ng m\u1edbi c\u00f3 gi\u00e1 tr\u1ecb.<\/p>\n

– Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y n\u00f3i chuy\u1ec7n v\u1edbi ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

– Ho\u1eb7c l\u00e0m nghi\u1ec7m ph\u00e1p Jendrassk (m\u00f3c hai tay k\u00e9o m\u1ea1nh trong l\u00fac th\u1ea7y thu\u1ed1c g\u00f5 ph\u1ea3n x\u1ea1 b\u00e1nh ch\u00e8).<\/p>\n

b.Kh\u00e1m m\u1ed9t s\u1ed1 ph\u1ea3n x\u1ea1 ch\u00ednh: kh\u00e1m \u1edf t\u01b0 th\u1ebf n\u1eb1m ho\u1eb7c ng\u1ed3i.<\/p>\n

– Ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng chi tr\u00ean<\/p>\n

– Ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng quay: \u0111\u1ecba \u0111i\u1ec3m g\u00f5 m\u1ecfm tr\u00e2m quay. Ph\u1ea3n x\u1ea1 xh g\u1ea5p c\u1eb3ng tay do co c\u01a1 ng\u1eeda d\u00e0i.<\/p>\n

– Ph\u1ea3n x\u1ea1 tam \u0111\u1ea7u: g\u00f5 g\u00e2n c\u01a1 tam \u0111\u1ea7u, du\u1ed7i c\u1eb3ng tay.<\/p>\n

– Ph\u1ea3n x\u1ea1 g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u: g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u, co c\u1eb3ng tay.<\/p>\n

– Ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng chi d\u01b0\u1edbi:<\/p>\n

– Ph\u1ea3n x\u1ea1 g\u00e2n b\u00e1nh ch\u00e8: g\u00f5 g\u00e2n t\u1ee9 \u0111\u1ea7u \u0111\u00f9i, h\u1ea5t c\u1eb3ng ch\u00e2n ra tr\u01b0\u1edbc.<\/p>\n

– Ph\u1ea3n x\u1ea1 g\u00f3t: g\u00f5 g\u00e2n g\u00f3t, gi\u1eadt c\u01a1 tam \u0111\u1ea7u c\u1eb3ng ch\u00e2n.<\/p>\n

c. Nh\u1eefng thay \u0111\u1ed5i b\u1ec7nh l\u00fd:<\/p>\n

– T\u0103ng ph\u1ea3n x\u1ea1:<\/p>\n

+ Co gi\u1eadt \u0111o\u1ea1n chi \u0111\u1ed9t ng\u1ed9t, m\u1ea1nh, bi\u00ean \u0111\u1ed9 r\u1ed9ng. M\u1ee9c \u0111\u1ed9 cao h\u01a1n l\u00e0 lan truy\u1ec1n, v\u00e0 \u0111a \u0111\u1ed9ng.<\/p>\n

+ Gi\u00e1 tr\u1ecb tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u0103ng ph\u1ea3n x\u1ea1: c\u00f3 t\u1ed5n th\u01b0\u01a1ng b\u00f3 th\u00e1p th\u1ea7nkinh trung \u01b0\u01a1ng.<\/p>\n

+ Th\u01b0\u1eddng t\u0103ng ph\u1ea3n x\u1ea1 \u0111i \u0111\u00f4i v\u1edbi t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1, nh\u01b0ng trong tr\u01b0\u1eddng h\u1ee3p li\u1ec7t m\u1ec1m chuy\u1ec3n sang li\u1ec7t c\u1ee9ng ph\u1ea3n x\u1ea1 t\u0103ng nh\u01b0ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1 gi\u1ea3m.<\/p>\n

– Gi\u1ea3m ho\u1eb7c m\u1ea5t ph\u1ea3n x\u1ea1:<\/p>\n

+ C\u01a1 kh\u00f4ng gi\u1eadt t\u00ed n\u00e0o, ho\u1eb7c c\u01a1 gi\u1eadt y\u1ebfu.<\/p>\n

+ Gi\u1ea3m ho\u1eb7c m\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng, ch\u1ee9ng t\u1ecf c\u00f3 t\u1ed5n th\u01b0\u01a1ng cung ph\u1ea3n x\u1ea1. C\u00f3 th\u1ec3 g\u1eb7p t\u1ed5n th\u01b0\u01a1ng b\u00f3 th\u00e1p \u0111\u1ed9t ng\u1ed9t hay \u0111\u1ee9t ngang t\u1ee7y.<\/p>\n

– Ph\u1ea3n x\u1ea1 \u0111\u1ea3o ng\u01b0\u1ee3c: g\u00f5 \u0111\u00fang quy \u0111\u1ecbnh nh\u01b0ng chi gi\u1eadt ng\u01b0\u1ee3c<\/p>\n

Ph\u1ea3n x\u1ea1<\/p>\n

N\u01a1i k\u00edch th\u00edch<\/p>\n

N\u01a1i \u0111\u00e1p \u1ee9ng<\/p>\n

T\u1ea7ng t\u1ee7y li\u00ean h\u1ec7<\/p>\n

Ghi ch\u00fa<\/p>\n

Tr\u1ee5 tr\u00e2m<\/p>\n

S\u00e1t m\u1ea5u tr\u00e2m x\u01b0\u01a1ng tr\u1ee5<\/p>\n

C\u1ed5 tay chuy\u1ec3n trong<\/p>\n

C8<\/p>\n

C\u00e1nh tay n\u1eeda g\u1ea5p, ng\u1eeda nh\u1eb9<\/p>\n

Tr\u00e2m quay<\/p>\n

Tr\u00ean m\u1ea5u tr\u00e2m quay<\/p>\n

– C\u01a1 ng\u1eeda.<\/p>\n

– C\u01a1 nh\u1ecb \u0111\u1ea7u c\u00e1nh tay l\u00e0m c\u1eb3ng tay g\u1ea5p v\u00e0 xoay ng\u1eeda<\/p>\n

C5-C7<\/p>\n

B\u1edd x\u01b0\u01a1ng quay h\u01b0\u1edbng l\u00ean tr\u00ean<\/p>\n

C\u01a1 tam \u0111\u1ea7u<\/p>\n

G\u00e2n c\u01a1 tam \u0111\u1ea7u ph\u00eda tr\u00ean khu\u1ef7u tay<\/p>\n

C\u01a1 tam \u0111\u1ea7u l\u00e0m khu\u1ef7u tay du\u1ed7i<\/p>\n

C6-C8<\/p>\n

C\u00e1nh tay, b\u00e0n tay \u0111\u01b0a ra ngo\u00e0i<\/p>\n

C\u01a1 nh\u1ecb \u0111\u1ea7u<\/p>\n

G\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u \u1edf n\u1ebfp c\u1eb3ng tay<\/p>\n

– C\u01a1 nh\u1ecb \u0111\u1ea7u tay.<\/p>\n

-C\u01a1 c\u00e1nh tay tr\u01b0\u1edbc l\u00e0m khu\u1ef7u tay g\u1ea5p<\/p>\n

C5- C6<\/p>\n

Ng\u00f3n c\u00e1i \u0111\u1eb7t \u1edf g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u<\/p>\n

G\u1ed1i<\/p>\n

G\u00e2n c\u01a1 t\u1ee9 \u0111\u1ea7u<\/p>\n

C\u01a1 t\u1ee9 \u0111\u1ea7u \u0111\u00f9i l\u00e0m du\u1ed7i g\u1ed1i<\/p>\n

L3-L4-L5<\/p>\n

Ng\u1ed3i th\u1ecfng ch\u00e2n ho\u1eb7c ng\u1ed3i b\u1eaft ch\u00e9o ch\u00e2n<\/p>\n

G\u00f3t<\/p>\n

G\u00e2n Achille<\/p>\n

C\u01a1 tam \u0111\u1ea7u \u0111\u00f9i l\u00e0m g\u1eadp l\u00f2ng b\u00e0n ch\u00e2n<\/p>\n

S1-S2<\/p>\n

BN qu\u1ef3 g\u1ed1i, n\u1ebfu n\u1eb1m s\u1ea5p hai c\u1ea3ng ch\u00e2n \u0111\u01b0a th\u1eb3ng g\u00f3c v\u1edbi gi\u01b0\u1eddng<\/p>\n

2. Ph\u1ea3n x\u1ea1 da, ni\u00eam m\u1ea1c.<\/p>\n

a. Ph\u1ea3n x\u1ea1 da.<\/p>\n

– Ph\u1ea3n x\u1ea1 da b\u1ee5ng: d\u00f9ng v\u1eadt nh\u1ecdn nh\u01b0ng kh\u00f4ng qu\u00e1 s\u1eaft \u0111\u1ec3 k\u00edch th\u00edch. C\u00f3 ba trung t\u00e2m kh\u00e1c nhau, da b\u1ee5ng tr\u00ean: k\u00edch th\u00edch tr\u00ean r\u1ed1n, da b\u1ee5ng gi\u1eefa: k\u00edch th\u00edch gi\u1eefa r\u1ed1n, da b\u1ee5ng d\u01b0\u1edbi: k\u00edch th\u00edch d\u01b0\u1edbi r\u1ed1n. \u0110\u00e1p \u1ee9ng ph\u1ea3n x\u1ea1 c\u01a1 b\u1ee5ng co gi\u1eadt, r\u1ed1n nh\u01b0 r\u00fam (co nh\u00fam) l\u1ea1i.<\/p>\n

– Ph\u1ea3n x\u1ea1 da b\u00ecu: K\u00edch th\u00edch 1\/3 tr\u00ean m\u1eb7t trong \u0111\u00f9i. Da b\u00ecu co r\u00fam l\u1ea1i, tinh ho\u00e0n \u0111i l\u00ean tr\u00ean. Gi\u1ea3m ho\u1eb7c m\u1ea5t t\u1ee9c b\u1ec7nh l\u00fd, c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh.<\/p>\n

– D\u1ea5u Babinski (ph\u1ea3n x\u1ea1 da l\u00f2ng b\u00e0n ch\u00e2n)<\/p>\n

K\u00edch th\u00edch d\u1ecdc b\u1edd ngo\u00e0i b\u00e0n ch\u00e2n v\u00f2ng \u0111\u1ebfn c\u00e1c n\u1ebfp g\u1ea5p ng\u00f3n ch\u00e2n. Ph\u1ea3n x\u1ea1 xu\u1ea5t hi\u1ec7n l\u00e0 ng\u00f3n c\u00e1i v\u00e0 c\u00e1c ng\u00f3n kh\u00e1c c\u1ee5p xu\u1ed1ng trong tr\u01b0\u1eddng h\u1ee3p b\u00ecnh th\u01b0\u1eddng. B\u1ec7nh l\u00fd l\u00e0 c\u00e1c ng\u00f3n c\u00e1i du\u1ed7i ra, c\u00e1c ng\u00f3n kh\u00e1c x\u00f2e ra nh\u01b0 nang qu\u1ea1t, d\u1ea5u babinski (+) c\u00f3 gi\u00e1 tr\u1ecb tuy\u1ec7t \u0111\u1ed1i tr\u00ean l\u00e2m s\u00e0ng, ch\u1ee9ng t\u1ecf c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1ef1c th\u1ec3 b\u00f3 th\u00e1p, n\u00ean th\u1eadn tr\u1ecdng kh\u00e1m \u0111i kh\u00e1m l\u1ea1i nhi\u1ec1u l\u1ea7n. C\u00f3 nh\u1eefng bi\u1ec7n ph\u00e1p kh\u00e1c nhau \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng b\u00f3 th\u00e1p c\u00f3 gi\u00e1 tr\u1ecb nh\u01b0 Babinski, nh\u01b0 Oppeheim, Gordon, Schaeffer, ho\u1eb7c \u1edf chi tr\u00ean c\u00f3 d\u1ea5u Hoffman.<\/p>\n

b. Ph\u1ea3n x\u1ea1 ch\u1ed1ng \u0111\u1ee1.<\/p>\n

Ph\u1ea3n x\u1ea1 n\u00e0y ch\u1ec9 xu\u1ea5t hi\u1ec7n khi b\u1ec7nh l\u00fd. Khi k\u00edch th\u00edch s\u1ebd xu\u1ea5t hi\u1ec7n th\u01b0\u1eddng g\u1eb7p l\u00e0 d\u1ea5u hi\u1ec7u ba co, g\u1ecdi l\u00e0 ph\u1eadn thu ng\u1eafn, b\u00e0n ch\u00e2n co v\u00e0o c\u1eb3ng ch\u00e2n, c\u1eb3ng ch\u00e2n co v\u00e0 \u0111\u00f9i, \u0111\u00f9i co v\u00e0o m\u00ecnh. \u0110\u00e2y l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng t\u1ef1 \u0111\u1ed9ng t\u1ee7y, do t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o th\u1ea7n kinh trung \u01b0\u01a1ng, g\u1eb7p trong li\u1ec7t c\u1ee9ng do \u00e9p t\u1ee7y. C\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n quy\u1ebft \u0111\u1ecbnh v\u00e0 v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng, n\u1ebfu k\u00edch th\u00edch t\u1eeb d\u01b0\u1edbi l\u00ean, ch\u1ed7 n\u00e0o kh\u00f4ng xu\u1ea5t hi\u1ec7n d\u1ea5u hi\u1ec7u ba co t\u1ee9c l\u00e0 gi\u1edbi h\u1ea1n gi\u1eefa t\u1ee7y b\u1ecb \u00e9p v\u00e0 ch\u1ed7 l\u00e0nh.<\/p>\n

III. D\u1ea5u hi\u1ec7u Hoffmann<\/p>\n

B\u00e0y tay ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ec3 s\u1ea5p, c\u1ea7m \u0111\u1ea7u ng\u00f3n tay gi\u1eefa b\u1eadt v\u00e0i c\u00e1i<\/p>\n

D\u1ea5u hi\u1ec7u Hoffmann (+) khi m\u1ed7i l\u1ea7n b\u1eadt nh\u01b0 v\u1eady, ng\u00f3n c\u00e1i v\u00e0 ng\u00f3n tr\u1ecf ng\u01b0\u1eddi b\u1ec7nh s\u1ebd c\u00f3 \u0111\u1ed9ng t\u00e1c kh\u00e9p l\u1ea1i nh\u01b0 g\u1ecdng k\u00ecm.<\/p>\n

\u0110\u00e1nh gi\u00e1: khi b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 \u0111\u00e1p \u1ee9ng ho\u1eb7c \u0111\u00e1p \u1ee9ng nh\u1eb9 co c\u01a1 (gi\u1ea3m ho\u1eb7c m\u1ea5t) t\u1ee9c l\u00e0 b\u1ec7nh l\u00fd ch\u1ee9ng t\u1ecf c\u00f3 t\u1ed5n th\u01b0\u01a1ng b\u00f3 th\u00e1p.C\u00e2u 19: Tr\u00ecnh b\u00e0y Kh\u00e1m c\u1ea3m gi\u00e1c?<\/p>\n

C\u1ea3m gi\u00e1c c\u00f3 nhi\u1ec1u lo\u1ea1i: c\u1ea3m gi\u00e1c ch\u1ee7 quan v\u00e0 c\u1ea3m gi\u00e1c kh\u00e1ch quan. C\u1ea3m gi\u00e1c kh\u00e1ch quan g\u1ed3m c\u1ea3m gi\u00e1c n\u00f4ng v\u00e0 c\u1ea3m gi\u00e1c s\u00e2u:<\/p>\n

C\u1ea3m gi\u00e1c n\u00f4ng g\u1ed3m: s\u1edd, \u0111au, n\u00f3ng, l\u1ea1nh do b\u00f3 Djerimi ph\u1ee5 tr\u00e1ch.<\/p>\n

C\u1ea3m gi\u00e1c s\u00e2u g\u1ed3m c\u00f3 c\u1ea3m gi\u00e1c t\u01b0 th\u1ebf, v\u1ecb tr\u00ed, c\u1ea3m gi\u00e1c rung x\u01b0\u01a1ng, nh\u1eadn th\u1ee9c \u0111\u1ed3 v\u1eadt, do b\u00f3 Goll v\u00e0 Burdach, c\u00e1c b\u00f3 ti\u1ec3u n\u00e3o th\u1eb3ng, ch\u00e9o ph\u1ee5 tr\u00e1ch.<\/p>\n

1. Ph\u00e1t hi\u1ec7n r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c.<\/p>\n

– Nguy\u00ean t\u1eafc v\u00e0 k\u1ef9 thu\u1eadt kh\u00e1m: ph\u1ea3i l\u00e0m ng\u01b0\u1eddi b\u1ec7nh an t\u00e2m, v\u00e0 gi\u1ea3i th\u00edch tr\u01b0\u1edbc khi kh\u00e1m.<\/p>\n

– C\u1ea7n n\u1eafm v\u1eefng c\u00e1c s\u01a1\u0111\u1ed3 v\u00f9ng c\u1ea3m gi\u00e1c, D5\u1edf ngang v\u00fa, D10 \u1edf ngang r\u1ed1n.<\/p>\n

– K\u1ef9 thu\u1eadt kh\u00e1m:<\/p>\n

\u00fc C\u1ea3m gi\u00e1c n\u00f4ng: c\u1ea3m gi\u00e1c s\u1edd, d\u00f9ng b\u00fat l\u00f4ng qu\u1ec7t v\u00e0o trong v\u00f9ng da ng\u01b0\u1eddi b\u1ec7nh. C\u1ea3m gi\u00e1c \u0111au d\u00f9ng \u0111\u1ea7u kim ch\u00e2m v\u00e0o da. C\u1ea3m gi\u00e1c n\u00f3ng l\u1ea1nh d\u00f9ng \u1ed1ng nghi\u1ec7m \u0111\u1ef1ng n\u01b0\u1edbc \u0111\u00e1\u0111ang tan v\u00e0 \u1ed1ng kh\u00e1c \u0111\u1ef1ng n\u01b0\u1edbc n\u00f3ng \u00e1p v\u00e0o da b\u1ec7nh nh\u00e2n.<\/p>\n

\u00fc C\u1ea3m gi\u00e1c s\u00e2u: c\u1ea3m gi\u00e1c rung, kh\u00e1m b\u1eb1ng c\u00e1ch d\u00f9ng \u00e2m thoa, c\u1ea3m gi\u00e1c t\u01b0 th\u1ebf, v\u1ecb tr\u00ed, ph\u1ea7n x\u00e1c \u0111\u1ecbnh s\u01a1 c\u1ea5p (s\u1edd), ph\u1ea7n x\u00e1c \u0111\u1ecbnh cao c\u1ea5p (nh\u1eadn bi\u1ebft \u0111\u1ed3 v\u1eadt).<\/p>\n

2. Gi\u00e1 tr\u1ecb tri\u1ec7u ch\u1ee9ng:<\/p>\n

– C\u1ea3m gi\u00e1c n\u00f4ng: c\u1ea7n x\u00e1c \u0111\u1ecbnh khu tr\u00fa v\u00f9ng m\u1ea5t c\u1ea3m gi\u00e1c, th\u01b0\u1eddng th\u00ec b\u1ec7nh nh\u00e2n b\u1ecb m\u1ea5t ba c\u1ea3m gi\u00e1c l\u00e0 s\u1edd, \u0111au, n\u00f3ng l\u1ea1nh, nh\u01b0ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p c\u1ea3m gi\u00e1c s\u1edd v\u1eabn c\u00f2n, ch\u1ec9 m\u1ea5t c\u1ea3m gi\u00e1c \u0111au v\u00e0 n\u00f3ng l\u1ea1nh, tr\u01b0\u1eddng h\u1ee3p n\u00e0y g\u1ecdi l\u00e0 ph\u00e2n ly c\u1ea3m gi\u00e1c g\u1eb7p trong \u1ed1ng s\u00e1o t\u1ee7y (r\u1ed7ng \u1ed1ng t\u1ee7y s\u1ed1ng).<\/p>\n

– C\u1ea3m gi\u00e1c s\u00e2u:<\/p>\n

+ C\u1ea3m gi\u00e1c t\u01b0 th\u1ebf, v\u1ecb tr\u00ed: m\u1ea5t c\u1ea3m gi\u00e1c t\u01b0 th\u1ebf v\u1ecb tr\u00ed th\u01b0\u1eddng g\u1eb7p trong b\u1ec7nh tabet v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c \u1edf s\u1eebng sau t\u1ee7y s\u1ed1ng, h\u1ed9i ch\u1ee9ng \u0111\u1ed3i th\u1ecb.<\/p>\n

+ Nh\u1eadn bi\u1ebft \u0111\u1ed3 v\u1eadt: ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng nh\u1eadn bi\u1ebft n\u1eb7ng nh\u1eb9 c\u1ee7a v\u1eadt: t\u1ed5n th\u01b0\u01a1ng v\u1ecf n\u00e3o v\u00f9ng th\u00e1i d\u01b0\u01a1ng b\u00ean \u0111\u1ed1i di\u1ec7n. N\u1ebfu kh\u00f4ng nh\u1eadn bi\u1ebft \u0111\u01b0\u1ee3c v\u1eadt g\u00ec t\u1ed5n th\u01b0\u01a1ng v\u1ecf n\u00e3o hay th\u1ec3 trai.<\/p>\n

C\u00e2u 24 : Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m 12 \u0111\u00f4i d\u00e2y TH\u1ea6N KINH S\u1ecc<\/p>\n

I. TH\u1ea6N KINH KH\u01af\u1edaU GI\u00c1C (D\u00e2y I)<\/p>\n

– C\u00e1ch th\u1eed th\u01b0\u1eddng d\u00f9ng c\u00e1c ch\u1ea5t tinh d\u1ea7u c\u00f3 m\u00f9i d\u1ecbu nh\u01b0 n\u01b0\u1edbc hoa, m\u00f9i x\u00e0 ph\u00f2ng th\u01a1m, thu\u1ed1c l\u00e1, c\u00e0 ph\u00ea… nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c c\u00f3 t\u00ednh ch\u1ea5t k\u00edch th\u00edch th\u1ea7n kinh V<\/p>\n

– L\u1ea7n l\u01b0\u1ee3t b\u1ecbt 1 b\u00ean m\u0169i cho 5 ng\u1eedi v\u00e0 y\u00eau c\u1ea7u BN n\u00f3i v\u00e0 ph\u00e2n bi\u1ec7t c\u00e1c m\u00f9i (B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 b\u1ec7nh v\u1ec1 m\u0169i, kh\u00f4ng b\u1ecb ngh\u1eb9t m\u0169i hay c\u1ea3m c\u00fam)<\/p>\n

– C\u00e1c tri\u1ec7u ch\u1ee9ng \u00edt c\u00f3 gi\u00e1 tr\u1ecb: Hyperosmie: t\u0103ng c\u1ea3m gi\u00e1c m\u00f9i; parosmie: l\u1eabn m\u00f9i<\/p>\n

– M\u1ea5t m\u00f9i: anosmie, tri\u1ec7u ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh I<\/p>\n

II. TH\u1ea6N KINH TH\u1eca GI\u00c1C (D\u00e2y II)<\/p>\n

1. Kh\u00e1m th\u1ecb l\u1ef1c. B\u1ea3o ng\u01b0\u1eddi b\u1ec7nh nh\u00ecn c\u00e1c ng\u00f3n tay \u1edf kho\u1ea3ng c\u00e1ch kh\u00e1c nhau \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u01a1 b\u1ed9 v\u1ec1 th\u1ecb l\u1ef1c. Mu\u1ed1n ch\u00ednh x\u00e1c, ph\u1ea3i d\u00f9ng m\u1ed9t b\u1ea3ng in c\u00e1c m\u1eabu ch\u1eef c\u00f3 k\u00edch th\u01b0\u1edbc kh\u00e1c nhau. \u0110\u1ec3 b\u1ea3ng \u0111\u00f3 c\u00e1ch xa ng\u01b0\u1eddi b\u1ec7nh 5 m v\u00e0 ch\u1ec9 t\u1eebng lo\u1ea1i ch\u1eef cho ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ecdc, qua \u0111\u00f3 c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 xem th\u1ecb l\u1ef1c t\u1ed1t hay x\u1ea5u v\u00e0 c\u00f2n kho\u1ea3ng bao nhi\u00eau ph\u1ea7n 10.<\/p>\n

2. Kh\u00e1m th\u1ecb tr\u01b0\u1eddng: Nghi\u00ean c\u1ee9u s\u01a1 b\u1ed9 th\u1ecb tr\u01b0\u1eddng c\u00f3 th\u1ec3 d\u00f9ng ph\u01b0\u01a1ng ph\u00e1p sau \u0111\u00e2y: th\u1ea7y thu\u1ed1c ng\u1ed3i \u0111\u1ed1i di\u1ec7n c\u00e1ch ng\u01b0\u1eddi b\u1ec7nh 1m. n\u1ebfu mu\u1ed1n ki\u1ec3m tra m\u1eaft ph\u1ea3i, b\u1ea3o ng\u01b0\u1eddi b\u1ec7nh nh\u1eafm m\u1eaft tr\u00e1i ( ho\u1eb7c che m\u1eaft. Ph\u1ea3i th\u1eed nhi\u1ec1u l\u1ea7n sau \u0111\u00f3 ghi l\u1ea1i k\u1ebft qu\u1ea3 tr\u00ean h\u00ecnh v\u1ebd<\/p>\n

3. Kh\u00e1m \u0111\u1ed3ng t\u1eed: th\u1eed ph\u1ea3n x\u1ea1 \u0111\u1ed3ng t\u1eed v\u1edbi \u00e1nh s\u00e1ng: d\u00f9ng \u0111\u00e8n chi\u1ebfu ch\u1ebfch t\u1eeb ngo\u00e0i v\u00e0o, b\u00ecnh th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n \u0111\u1ed3ng t\u1eed co l\u1ea1i nhanh, \u0111\u1ed9t ng\u1ed9t v\u00e0 duy tr\u00ec khi c\u00f2n ngu\u1ed3n chi\u1ebfu s\u00e1ng v\u00e0 d\u00e3n ra ngay sau t\u1eaft \u0111\u00e8n<\/p>\n

4. Kh\u00e1m \u0111\u00e1y m\u1eaft:l\u00e0 kh\u00e2u quan tr\u1ecdng trong b\u1ec7nh th\u1ea7n kinh c\u1ea7n t\u1eadp trung s\u1ef1 ch\u00fa \u00fd ph\u00e1t hi\u1ec7n c\u00e1c bi\u1ebfn \u0111\u1ed5i c\u1ee7a gai th\u1ecb v\u00e0 c\u00e1c m\u1ea1ch m\u00e1u.<\/p>\n

Qua \u0111\u00e8n soi \u0111\u00e1y m\u1eaft: gai th\u1ecb b\u00ecnh th\u01b0\u1eddng m\u00e0u h\u1ed3ng to b\u1eb1ng chi\u1ebfc c\u00fac \u00e1o s\u01a1 mi b\u1edd gai r\u00f5 n\u00e9t. T\u1eeb gi\u1eefa gai th\u1ecb c\u1ee7a c\u00e1c \u0110M v\u00e0 TM ch\u1ee5m l\u1ea1i \u1edf trung t\u00e2m r\u1ed3i t\u1ecfa ra ngo\u00e0i chu vi<\/p>\n

III. D\u00c2Y TH\u1ea6N KINH V\u1eacN NH\u00c3N ( III, IV, VI):<\/p>\n

-Y\u00eau c\u1ea7u BN nh\u00ecn c\u1ed1 \u0111\u1ecbnh v\u00e0o 1 v\u1eadt ( ng\u00f3n tay th\u1ea7y thu\u1ed1c, \u0111\u1ea7u b\u00fat… ) sau \u0111\u00f3 di chuy\u1ec3n v\u1eadt ch\u1eadm theo chi\u1ec1u ngang, ph\u1ea3i \u2013 tr\u00e1i, tr\u00e1i \u2013 ph\u1ea3i, chi\u1ec1u d\u1ecdc; tr\u00ean d\u01b0\u1edbi, d\u01b0\u1edbi \u2013 tr\u00ean v\u00e0 theo chi\u1ec1u ch\u1ebfch d\u01b0\u1edbi \u2013 tr\u00ean, tr\u00ean \u2013 d\u01b0\u1edbi. BN \u0111\u01b0a m\u1eaft nh\u00ecn theo v\u1eadt nh\u01b0ng \u0111\u1ea7u v\u1eabn gi\u1eef im kh\u00f4ng quay. Sau \u0111\u00f3 v\u1eadt \u0111\u1ec3\u1edf \u0111\u01b0\u1eddng gi\u1eefa c\u00e1ch xa 2 m\u1eaft, \u0111\u01b0a d\u1ea7n v\u1eadt v\u00e0o s\u00e1t m\u1eaft c\u00e1ch 6cm, 2 nh\u00e3n c\u1ea7u s\u1ebd quy t\u1ee5 v\u00e0o ph\u00eda m\u0169i v\u00e0 \u0111\u1ed3ng t\u1eed co l\u1ea1i. N\u1ebfu \u0111\u01b0a v\u1eadt ra xa d\u1ea7n 2 m\u1eaft s\u1ebd tr\u1edf v\u1ec1 v\u1ecb tr\u00ed c\u0169 v\u00e0 \u0111\u1ed3ng t\u1eed d\u00e3n ra<\/p>\n

-Khi li\u1ec7t d\u00e2y III (d\u00e2y v\u1eadn nh\u00e3n chung) c\u00f3 th\u1ec3 th\u1ea5y: – S\u1ee5p mi, do li\u1ec7t c\u01a1 n\u00e2ng mi tr\u00ean. – M\u1eaft ch\u1ec9 c\u00f3 th\u1ec3 \u0111\u01b0a ra ngo\u00e0i v\u00e0 \u0111\u01b0a nh\u1eb9 xu\u1ed1ng th\u1ea5p. – M\u1eaft l\u00e1c ngo\u00e0i (c\u01a1 th\u1eb3ng ngo\u00e0i do d\u00e2y VI chi ph\u1ed1i s\u1ebd k\u00e9o m\u1eaft ra ngo\u00e0i)..<\/p>\n

-D\u00e2y IV \u00edt khi li\u1ec7t \u0111\u01a1n \u0111\u1ed9c m\u00e0 th\u01b0\u1eddng ph\u1ed1i h\u1ee3p v\u1edbi d\u00e2y III<\/p>\n

-Khi li\u1ec7t d\u00e2y VI ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng th\u1ec3 \u0111\u01b0a m\u1eaft ra ngo\u00e0i. Ng\u01b0\u1eddi b\u1ec7nh nh\u00ecn \u0111\u00f4i khi nh\u00ecn ra ngo\u00e0i.<\/p>\n

IV. D\u00c2Y TH\u1ea6N KINH TAM THOA (D\u00e2y V)<\/p>\n

1. Ph\u1ea7n v\u1eadn \u0111\u1ed9ng:<\/p>\n

+Quan s\u00e1t v\u00e0 s\u1edd kh\u1ed1i c\u01a1 nhai v\u00e0 c\u01a1 th\u00e1i d\u01b0\u01a1ng, cho b\u1ec7nh nh\u00e2n c\u1eafn v\u00e0o c\u00e2y \u0111\u00e8 l\u01b0\u1ee1i \u0111\u1ec3 d\u00e1nh gi\u00e1 s\u1ee9c c\u01a1<\/p>\n

+ B\u1ec7nh nh\u00e2n h\u00e1 mi\u1ec7ng, n\u1ebfu li\u1ec7t c\u01a1 nhai h\u00e0m d\u01b0\u1edbi s\u1ebd \u0111\u01b0a v\u1ec1 ph\u00eda b\u00ean li\u1ec7t<\/p>\n

+ T\u1ed5n th\u01b0\u01a1ng m\u00e3n t\u00ednh c\u00f3 th\u1ec3 l\u00e0m teo c\u01a1 nhai v\u00e0 c\u01a1 th\u00e1i d\u01b0\u01a1ng<\/p>\n

2. Ph\u1ea7n c\u1ea3m gi\u00e1c: kh\u00e1m c\u1ea3m gi\u00e1c v\u00f9ng m\u1eb7t: c\u1ea3m gi\u00e1c x\u00fac gi\u00e1c n\u00f4ng, nhi\u1ec7t, \u0111au, rung \u00e2m thoa.<\/p>\n

V. D\u00c2Y TH\u1ea6N KINH M\u1eb6T. (D\u00e2y VII)<\/p>\n

1. V\u1eadn \u0111\u1ed9ng:<\/p>\n

+Quan s\u00e1t v\u1ebd m\u1eb7t b\u1ec7nh nh\u00e2n: ghi nh\u1eadn s\u1ef1 b\u1ea5t \u0111\u1ed1i s\u1ee9ng, n\u1ebfp m\u00e1 \u2013 m\u0169i, l\u00f4ng m\u00e0y<\/p>\n

+V\u1eadn \u0111\u1ed9ng c\u00e1c c\u01a1 m\u1eb7t: nhe r\u0103ng, nh\u0103n tr\u00e1n, c\u01b0\u1eddi, hu\u00fdt gi\u00f3<\/p>\n

2. C\u1ea3m gi\u00e1c:<\/p>\n

+C\u1ea3m gi\u00e1c b\u00e1n th\u1ec3 : v\u00f9ng ramsay hunt<\/p>\n

+V\u1ecb gi\u00e1c 2\/3 tr\u01b0\u1edbc l\u01b0\u1ee1i : kh\u00e1m v\u1edbi n\u01b0\u1edbc mu\u1ed1i, \u0111\u01b0\u1eddng<\/p>\n

3. Ph\u00e2n ti\u1ebft:<\/p>\n

+Tuy\u1ebfn d\u01b0\u1edbi h\u00e0m v\u00e0 l\u01b0\u1ee1i: quan s\u00e1t s\u1ef1 ph\u00e2n ti\u1ebft<\/p>\n

+Tuy\u1ebfn l\u1ec7: kh\u00e1m b\u1eb1ng gi\u1ea5y th\u1ea5m.<\/p>\n

VI. TH\u1ea6N KINH VIII (D\u00c2Y TH\u1ea6N KINH \u1ed0C TAI, TI\u1ec0N \u0110\u00ccNH)<\/p>\n

1. Kh\u00e1m d\u00e2y VIII th\u00ednh gi\u00e1c: c\u00e1ch th\u1eed \u0111\u01a1n gi\u1ea3n l\u00e0 cho Bn nghe ti\u1ebfng t\u00edch t\u1eafc c\u1ee7a \u0111\u1ed3ng h\u1ed3 \u0111eo tay v\u00e0 so s\u00e1nh c\u00f3 b\u00ean n\u00e0o nghe k\u00e9m. B\u1eadt 2 \u0111\u1ea7u ng\u00f3n tay \u1edf \u0111\u1ed9 c\u00e1ch tai kh\u00e1c nhau xem b\u00ean n\u00e0o nghe r\u00f5 h\u01a1n. N\u00f3i to r\u1ed3i n\u00f3i th\u1ea7m xem BN tr\u1ea3 l\u1eddi c\u00f3 \u0111\u00fang kh\u00f4ng. Mu\u1ed1n th\u1eadt ch\u00ednh x\u00e1c, ph\u1ea3i d\u00f9ng m\u1ed9t th\u00ednh l\u1ef1c k\u1ebf<\/p>\n

2. Kh\u00e1m d\u00e2y ti\u1ec1n \u0111\u00ecnh:<\/p>\n

+D\u1ea5u hi\u1ec7u Romberg: ta \u0111\u1ec3 \u0111\u1ea7u BN v\u1ec1 h\u01b0\u1edbng n\u00e0o th\u00ec BN ng\u00e3 v\u1ec1 h\u01b0\u1edbng \u0111\u00f3<\/p>\n

+Nghi\u1ec7m ph\u00e1p l\u1ec7ch ng\u00f3n tr\u1ecf: BN dang tay th\u1eb3ng ra tr\u01b0\u1edbc x\u00f2e 2 ng\u00f3n tr\u1ecf ch\u1ec9 v\u00e0o 2 ng\u00f3n tr\u1ecf c\u1ee7a th\u1ea7y thu\u1ed1c l\u00e0m m\u1ed1c v\u00e0 gi\u1eef nguy\u00ean t\u01b0 th\u1ebf \u1ea5y ng\u00f3n tr\u1ecf s\u1ebd ch\u1ec9 l\u1ec7ch d\u1ea7n v\u1ec1 b\u00ean t\u1ed5n th\u01b0\u01a1ng<\/p>\n

+Nghi\u1ec7m ph\u00e1p \u0111i h\u00ecnh sao: BN nh\u1eafm m\u1eaft \u0111i th\u1eb3ng l\u00ean tr\u01b0\u1edbc 5-6m r\u1ed3i kh\u00f4ng \u0111\u01b0\u1ee3c quay ng\u01b0\u1eddi \u0111i l\u00f9i l\u1ea1i \u0111\u00fang \u0111\u01b0\u1eddng c\u0169, c\u1ee9 th\u1ebf l\u00e0m nhi\u1ec1u l\u1ea7n h\u01b0\u1edbng \u0111i s\u1ebd l\u1ec7ch d\u1ea7n t\u1ea1o n\u00ean h\u00ecnh sao<\/p>\n

+Rung gi\u1eadt nh\u00e3n c\u1ea7u: y\u00eau c\u1ea7u BN li\u1ebfc ngang, tr\u00e1i \u2013 ph\u1ea3i, ph\u1ea3i \u2013 tr\u00e1i, tr\u00ean – d\u01b0\u1edbi \u0111\u1ec3 nh\u00ecn c\u1ed1 \u0111\u1ecbnh v\u00e0o v\u1eadt, rung gi\u1eadt nh\u00e3n c\u1ea7u n\u1ebfu ta th\u1ea5y nh\u00e3n c\u1ea7u BN c\u00f3 \u0111\u1ed9ng t\u00e1c gi\u1eadt nhanh v\u1ec1 1 ph\u00eda r\u1ed3i ti\u1ebfp \u0111\u1ebfn 1 \u0111\u1ed9ng t\u00e1c ch\u1eadm h\u01a1n ng\u01b0\u1ee3c chi\u1ec1u v\u00e0 c\u1ee9 th\u1ebf xu\u1ea5t hi\u1ec7n nhi\u1ec1u l\u1ea7n<\/p>\n

VII. D\u00c2Y TH\u1ea6N KINH IX(D\u00c2Y TH\u1ea6N KINH THI\u1ec6T H\u1ea6U )<\/p>\n

– Th\u1ea7n kinh IX r\u1ea5t kh\u00f3 kh\u00e1m v\u00ec c\u00f3 c\u00e1c bu\u1ed3ng chi ph\u1ed1i chung v\u1edbi c\u00e1c th\u1ea7n kinh kh\u00e1c<\/p>\n

– C\u00f3 th\u1ec3 kh\u00e1m c\u1ea3m gi\u00e1c v\u00f9ng amidan v\u00e0 th\u00e0nh sau h\u1ecdng, c\u1ea3m gi\u00e1c v\u1ecb gi\u00e1c 1\/3 sau l\u01b0\u1ee1i. Kh\u00e1m b\u1eb1ng quinine<\/p>\n

– C\u1ea3m gi\u00e1c m\u00e0ng nh\u0129 v\u00e0 \u1ed1ng tai ngo\u00e0i th\u01b0\u1eddng kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c<\/p>\n

-Ph\u1ea3n x\u1ea1 n\u00f4n: kh\u00e1m chung v\u1edbi th\u1ea7n kinh X<\/p>\n

-Ph\u1ea3n x\u1ea1 xoang \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh: k\u00edch th\u00edch xoang \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh l\u00e0m ch\u1eadm nh\u1ecbp tim, tuy nhi\u00ean ph\u1ea3n x\u1ea1 n\u00e0y nguy hi\u1ec3m v\u00ec c\u00f3 th\u1ec3 g\u00e2p c\u00e2n ng\u1ea5t hay tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o<\/p>\n

VIII. D\u00c2Y TH\u1ea6N KINH X (D\u00c2Y TH\u1ea6N KINH LANG THANG )<\/p>\n

Kh\u00e1m ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng :<\/p>\n

\u00b7 Kh\u00e1m v\u00f2m kh\u1ea9u m\u1ec1m: k\u00edch th\u00edch v\u00f2m kh\u1ea9u m\u1ec1m th\u00ec v\u00f2m kh\u1ea9u s\u1ebd co l\u00ean, t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh X g\u00e2y m\u1ea5t ph\u1ea3n x\u1ea1 v\u00f2m kh\u1ea9u<\/p>\n

\u00b7 D\u1ea5u v\u00e9n m\u00e0ng vernet: k\u00edch th\u00edch th\u00e0nh sau h\u1ecdng cho b\u1ec7nh nh\u00e2n n\u00f4n, th\u00e0nh sau h\u1ecdng b\u00ean li\u1ec7t s\u1ebd b\u1ecb k\u00e9o l\u1ec7ch sang ph\u00eda b\u00ean n\u00e0y<\/p>\n

\u00b7 C\u00e1c ph\u1ea3n x\u1ea1 n\u00f4n, nu\u1ed1t,ho<\/p>\n

IX.D\u00c2Y TH\u1ea6N KINH XI(D\u00c2Y TH\u1ea6N KINH PH\u1ee4)<\/p>\n

Kh\u00e1m ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng: Quan s\u00e1t: teo c\u01a1 \u1ee9c \u0111\u00f2n ch\u0169m, c\u01a1 thang b\u00ean li\u1ec7t.<\/p>\n

\u00b7 C\u01a1 thang: c\u00f3 ch\u1ee9c n\u0103ng n\u00e2ng vai, y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n n\u00e2ng hai vai l\u00ean, \u0111\u00e1nh gi\u00e1 s\u1ee9c c\u01a1 hai b\u00ean, n\u1ebfu li\u1ec7t th\u1ea7n kinh XI th\u00ec m\u1ed9t b\u00ean vai s\u1ec7 xu\u1ed1ng ho\u1eb7c kh\u00f4ng n\u00e2ng l\u00ean \u0111\u01b0\u1ee3c<\/p>\n

\u00b7 C\u01a1 \u1ee9c \u0111\u00f2n ch\u0169m: ch\u1ee9c n\u0103ng xoay \u0111\u1ea7u v\u00e0 \u0111\u01b0a c\u1eb1m sang b\u00ean \u0111\u1ed1i di\u1ec7n, c\u00f3 th\u1ec3 kh\u00e1m hai b\u00ean c\u00f9ng l\u00fac b\u1eb1ng c\u00e1ch cho b\u1ec7nh nh\u00e2n c\u00fai \u0111\u1ea7u xu\u1ed1ng v\u00e0 ng\u01b0\u1eddi kh\u00e1m ch\u1ed1ng l\u1ea1i \u0111\u1ed9ng t\u00e1c n\u00e0y<\/p>\n

X. D\u00c2Y TH\u1ea6N KINH XII (TH\u1ea6N KINH H\u1ea0 THI\u1ec6T)<\/p>\n

– Quan s\u00e1t l\u01b0\u1ee1i:<\/p>\n

\u00b7 Teo c\u01a1 l\u01b0\u1ee1i, rung gi\u1eadt b\u00f3 c\u01a1 l\u01b0\u1ee1i<\/p>\n

\u00b7 L\u01b0\u1ee1i l\u1ec7ch v\u1ec1 ph\u00eda b\u00ean li\u1ec7t khi le l\u01b0\u1ee1i, nh\u01b0ng n\u1ebfu kh\u00f4ng v\u1eadn \u0111\u1ed9ng th\u00ec l\u1ec7ch v\u1ec1 ph\u00eda b\u00ean l\u00e0nh<\/p>\n

\u00b7 Teo c\u01a1 l\u01b0\u1ee1i: l\u01b0\u1ee1i c\u00f3 c\u00e1c r\u00e3nh v\u00e0 nh\u0103n nheo<\/p>\n

\u00b7 Teo gai l\u01b0\u1ee1i trong c\u00e1c b\u1ec7nh n\u1ed9i khoa: thi\u1ebfu vitamin B12, B1<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng trung \u01b0\u01a1ng: li\u1ec7t nh\u1eb9 m\u1ed9t b\u00ean l\u01b0\u1ee1i<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng ngo\u1ea1i bi\u00ean: li\u1ec7t m\u1ed9t b\u00ean l\u01b0\u1ee1i k\u00e8m teo c\u01a1 v\u00e0 rung gi\u1eadt b\u00f3 s\u1ee3 c\u01a1, th\u01b0\u1eddng g\u1eb7p do s\u01a1 c\u1ee9ng c\u1ed9t b\u00ean teo c\u01a1, ung th\u01b0 v\u00f2m h\u1ecdng.<\/p>\n

C\u00e2u 25: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m l\u00e2m s\u00e0ng kh\u1edbp ?<\/p>\n

I. Tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n:<\/p>\n

– S\u1ed1t, g\u1ea7y s\u00fat, m\u1ec7t m\u1ecfi, thay \u0111\u1ed5i h\u00ecnh d\u00e1ng<\/p>\n

– C\u00e1c t\u1ed5n th\u01b0\u01a1ng \u1edf c\u00e1c t\u1ea1ng c\u00f3 li\u00ean quan:<\/p>\n

+ Kh\u00e1m c\u01a1: ph\u1ea7n l\u1edbn c\u00e1c b\u1ec7nh kh\u1edbp m\u1ea1n t\u00ednh \u0111\u1ec1u c\u00f3 teo c\u01a1 v\u00f9ng t\u01b0\u01a1ng \u1ee9ng<\/p>\n

+ Da v\u00e0 ni\u00eam m\u1ea1c: ch\u00fa \u00fd t\u00ecm c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u1edf da v\u00e0 ni\u00eam m\u1ea1c nh\u01b0 v\u1ea3y n\u1ebfn trong b\u1ec7nh vi\u00eam kh\u1edbp v\u1ea3y n\u1ebfn, ban \u0111\u1ecf h\u00ecnh c\u00e1nh b\u01b0\u1edbm \u1edf m\u1eb7t trong b\u1ec7nh luput, da d\u00e0y trong b\u1ec7nh x\u01a1 c\u1ee9ng b\u00ec…<\/p>\n

+ C\u00e1c h\u1ea1ch n\u1ed5i \u1edf d\u01b0\u1edbi da quanh kh\u1edbp: h\u1ea1t meynet trong th\u1ea5p kh\u1edbp c\u1ea5p, h\u1ea1t d\u01b0\u1edbi da trong vi\u00eam kh\u00f3p d\u1ea1ng th\u1ea5p, h\u1ea1t tophi trong b\u1ec7nh g\u00fat<\/p>\n

+ M\u1eaft: nhi\u1ec1u b\u1ec7nh kh\u1edbp c\u00f3 t\u1ed5n th\u01b0\u01a1ng m\u1eaft: vi\u00eam k\u1ebft m\u1ea1c trong h\u1ed9i ch\u1ee9ng reiter…+ Tim m\u1ea1ch: th\u1ea5p kh\u1edbp c\u1ea5p c\u00f3 vi\u00eam tim bi\u1ec3u hi\u1ec7n b\u1eb1ng nh\u1ecbp nhanh, ti\u1ebfng tim m\u1edd, nh\u1ecbp ng\u1ef1a phi, tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim…<\/p>\n

+ Ph\u1ed5i: kh\u1ed1i u \u1edf \u0111\u1ec9nh ph\u1ed5i, k\u00e8m tri\u1ec7u ch\u1ee9ng s\u01b0ng \u0111au kh\u1edbp \u0111i\u1ec3n h\u00ecnh, ng\u00f3n tay d\u00f9i tr\u1ed1ng (h\u1ed9i ch\u1ee9ngPierre-Marie).+Th\u1ea7n kinh: h\u1ed9i ch\u1ee9ng ch\u00e8n \u00e9p t\u1ee7y g\u1eb7p trong vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp c\u00f3 bi\u1ebfn d\u1ea1ng c\u1ed9t s\u1ed1ng m\u1ee9c \u0111\u1ed9 n\u1eb7ng.<\/p>\n

+ Th\u1eadn: nhi\u1ec1u b\u1ec7nh kh\u1edbp g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1eadn nh\u01b0 g\u00fat, luput ban \u0111\u1ecf<\/p>\n

II. TRI\u1ec6U CH\u1ee8NG C\u01a0 N\u0102NG<\/p>\n

1. \u0110au kh\u1edbp:<\/p>\n

L\u00e0 d\u1ea5u hi\u1ec7u hay g\u1eb7p nh\u1ea5t, ph\u1ea3i x\u00e1c \u0111\u1ecbnh \u0111\u00fang v\u1ecb tr\u00ed \u0111au ngay t\u1ea1i kh\u1edbp hay c\u00e1c ph\u1ea7n c\u1ea1nh kh\u1edbp nh\u01b0 x\u01b0\u01a1ng, c\u01a1, d\u00e2y ch\u1eb1ng. C\u1ea7n ph\u00e2n bi\u1ec7t tri\u1ec7u ch\u1ee9ng \u0111au kh\u1edbp v\u1edbi c\u1ea3m gi\u00e1c m\u1ecfi \u1edf c\u01a1 v\u00e0 kh\u1edbp trong c\u00e1c b\u1ec7nh to\u00e0n th\u00e2n nh\u01b0 c\u1ea3m c\u00fam, s\u1ed1t r\u00e9t, thi\u1ebfu m\u00e1u…<\/p>\n

– \u0110au do vi\u00eam:Th\u01b0\u1eddng \u0111au li\u00ean t\u1ee5c trong ng\u00e0y,c\u00f3 xu h\u01b0\u1edbng t\u0103ng nhi\u1ec1u v\u1ec1 \u0111\u00eam v\u00e0 s\u00e1ng.k\u00e8m theo c\u00e1c d\u1ea5u hi\u1ec7u s\u01b0ng n\u00f3ng \u0111\u1ecf\u2026 G\u1eb7p trong vi\u00eam kh\u1edbp<\/p>\n

– \u0110au kh\u00f4ng do vi\u00eam: \u0111au t\u0103ng khi b\u1ec7nh nh\u00e2n v\u1eadn \u0111\u1ed9ng, lao \u0111\u1ed9ng, gi\u1ea3m ho\u1eb7c h\u1ebft \u0111au khi b\u1ec7nh nh\u00e2n ngh\u1ec9 ng\u01a1i, th\u01b0\u1eddng g\u1eb7p trong tho\u00e1i ho\u00e1 kh\u1edbp, c\u00e1c d\u1ecb t\u1eadt b\u1ea9m sinh…<\/p>\n

2. H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng:<\/p>\n

– Bi\u1ec3u hi\u1ec7n b\u1eb1ng kh\u00f3 c\u1ea7m n\u1eafm, h\u1ea1n ch\u1ebf \u0111i l\u1ea1i, ng\u1ed3i x\u1ed5m…<\/p>\n

– Nguy\u00ean nh\u00e2n: t\u1ed5n th\u01b0\u01a1ng kh\u1edbp, t\u1ed5n th\u01b0\u01a1ng c\u01a1, t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh\u2026<\/p>\n

3. D\u1ea5u hi\u1ec7u c\u1ee9ng kh\u1edbp bu\u1ed5i s\u00e1ng: L\u00e0 1 d\u1ea5u hi\u1ec7u \u0111\u1eb7c bi\u1ec7t<\/p>\n

– Khi m\u1edbi ng\u1ee7 d\u1eady ng\u01b0\u1eddi b\u1ec7nh th\u1ea5y kh\u1edbp c\u1ee9ng \u0111\u1edd kh\u00f3 v\u1eadn \u0111\u1ed9ng, ph\u1ea3i sau m\u1ed9t th\u1eddi gian ho\u1eb7c sau nhi\u1ec1u l\u1ea7n c\u1eed \u0111\u1ed9ng kh\u1edbp th\u00ec m\u1edbi tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng.<\/p>\n

– V\u1ecb tr\u00ed hay: kh\u1edbp c\u1ed5 tay, b\u00e0n ng\u00f3n tay, kh\u1edbp g\u1ed1i v\u00e0 kh\u1edbp c\u1ed5 ch\u00e2n.<\/p>\n

– G\u1eb7p trong: vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp.<\/p>\n

4. D\u1ea5u hi\u1ec7u ph\u00e1 g\u1ec9 kh\u1edbp:<\/p>\n

Bi\u1ec3u hi\u1ec7n l\u00fac m\u1edbi ng\u1ee7 d\u1eady hay kh\u1edfi \u0111\u1ed9ng, sau th\u1eddi gian ngh\u1ec9 ng\u01a1i d\u00e0i BN th\u1ea5y kh\u1edbp v\u01b0\u1edbng v\u00e0 kh\u00f3 v\u1eadn \u0111\u1ed9ng nh\u01b0ng ch\u1ec9 sau v\u00e0i \u0111\u1ed9ng t\u00e1c kh\u1edfi \u0111\u1ed9ng th\u00ec d\u1ea5u hi\u1ec7u n\u00e0y m\u1ea5t \u0111i. Hay g\u1eb7p trong tho\u00e1i h\u00f3a kh\u1edbp<\/p>\n

5. C\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c<\/p>\n

– D\u1ea5u l\u1eafc r\u1eafc: Khi v\u0111 kh\u1edbp k\u00eau l\u1eafc r\u1eafc, th\u01b0\u1eddng kh\u00f4ng c\u00f3 \u00fd ngh\u0129a v\u1ec1 t\u1ed5n th\u01b0\u01a1ng kh\u1edbp, g\u1eb7p trong tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i<\/p>\n

– D\u1ea5u hi\u1ec7u b\u1eadt l\u00f2 xo: G\u1eb7p \u1edf 1 s\u1ed1 ng\u00f3n tay, th\u1ea5y kh\u00f3 v\u00e0 c\u0103ng khi g\u1eadp ho\u1eb7c du\u1ed7i, n\u1ebfu d\u00f9ng s\u1ee9c th\u00ec b\u1eadt ra 1 c\u00e1ch \u0111\u1ed9t ng\u1ed9t v\u00e0 nhanh. G\u1eb7p trong vi\u00eam bao g\u00e2n g\u1ea5p ng\u00f3n tay<\/p>\n

III. Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:<\/p>\n

Khi kh\u00e1m ph\u1ea3i c\u1eddi b\u1ecf qu\u1ea7n \u00e1o, b\u1ed9c l\u1ed9 to\u00e0n b\u1ed9 c\u00e1c kh\u1edbp c\u1ea7n kh\u00e1m. C\u1ea7n so s\u00e1nh 2 b\u00ean, so s\u00e1nh t\u1eebng ph\u1ea7n v\u00e0 so s\u00e1nh v\u1edbi ng\u01b0\u1eddi l\u00e0nh<\/p>\n

1. S\u01b0ng kh\u1edbp:<\/p>\n

L\u00e0 hi\u1ec7n t\u01b0\u1ee3ng kh\u1edbp to h\u01a1n b\u00ecnh th\u01b0\u1eddng. Tr\u1eeb kh\u1edbp h\u00e1ng \u1edf s\u00e2u kh\u00f3 quan s\u00e1t, ph\u1ea7n l\u1edbn c\u00e1c kh\u1edbp khi s\u01b0ng \u0111\u1ec1u c\u00f3 th\u1ec3 kh\u00e1m th\u1ea5y<\/p>\n

\u2013 S\u01b0ng kh\u1edbp do vi\u00eam: kh\u1edbp b\u1ecb vi\u00eam c\u00f3 s\u01b0ng, \u0111au, n\u00f3ng, \u0111\u1ecf. C\u00f3 th\u1ec3 c\u00f3 d\u1ecbch trong kh\u1edbp.<\/p>\n

\u2013 S\u01b0ng kh\u1edbp kh\u00f4ng do vi\u00eam: kh\u1edbp s\u01b0ng \u1edf \u0111\u00e2y do nh\u1eefng thay \u0111\u1ed5i \u1edf \u0111\u1ea7u x\u01b0\u01a1ng s\u1ee5n kh\u1edbp, ph\u1ea7n m\u1ec1m quanh kh\u1edbp\u2026. m\u00e0 kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a vi\u00eam.<\/p>\n

\u2013 V\u1ecb tr\u00ed kh\u1edbp s\u01b0ng: r\u1ea5t quan tr\u1ecdng, g\u1ee3i \u00fd c\u0103n b\u1ec7nh<\/p>\n

\u2013 S\u1ed1 l\u01b0\u1ee3ng kh\u1edbp s\u01b0ng: chia l\u00e0m 3 lo\u1ea1i:<\/p>\n

+ Vi\u00eam 1 kh\u1edbp: th\u01b0\u1eddng l\u00e0 vi\u00eam kh\u1edbp nhi\u1ec5m khu\u1ea9n<\/p>\n

+ Vi\u00eam v\u00e0i kh\u1edbp: t\u1eeb 2-3 kh\u1edbp, g\u1eb7p trong vi\u00eam kh\u1edbp ph\u1ea3n \u1ee9ng, th\u1ea5p kh\u1edbp c\u1ea5p<\/p>\n

+ Vi\u00eam \u0111a kh\u1edbp: 4 kh\u1edbp tr\u1edf l\u00ean, g\u1eb7p trong vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, g\u00fat m\u1ea1n t\u00ednh, luput ban \u0111\u1ecf<\/p>\n

\u2013 T\u00ednh \u0111\u1ed1i x\u1ee9ng c\u1ee7a kh\u1edbp vi\u00eam: g\u1ee3i \u00fd ch\u1ea9n \u0111o\u00e1n b\u1ec7nh. Vd: vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p c\u00f3 t\u00ednh \u0111\u1ed1i x\u1ee9ng, c\u00e1c kh\u1edbp vi\u00eam c\u1ee7a vi\u00eam kh\u1edbp ph\u1ea3n \u1ee9ng kh\u00f4ng \u0111\u1ed1i x\u1ee9ng<\/p>\n

\u2013 Di\u1ec5n bi\u1ebfn c\u1ee7a s\u01b0ng kh\u1edbp:<\/p>\n

+ Di chuy\u1ec3n t\u1eeb kh\u1edbp n\u00e0y sang kh\u1edbp kh\u00e1c-kh\u1edbp c\u0169 kh\u1ecfi ho\u00e0n to\u00e0n trong th\u1eddi gian ng\u1eafn< 1 tu\u1ea7n (hay g\u1eb7p trong b\u1ec7nh th\u1ea5p kh\u1edbp c\u1ea5p). + T\u0103ng d\u1ea7n: s\u01b0ng kh\u1edbp xu\u1ea5t hi\u1ec7n th\u00eam \u1edf c\u00e1c kh\u1edbp m\u1edbi, trong khi c\u00e1c kh\u1edbp c\u0169 v\u1eabn s\u01b0ng, \u0111au k\u00e9o d\u00e0i (hay g\u1eb7p trong b\u1ec7nh vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, G\u00fat m\u1ea1n t\u00ednh…). + Kh\u00f4ng di chuy\u1ec3n, c\u1ed1 \u0111\u1ecbnh: ch\u1ec9 t\u1ed5n th\u01b0\u01a1ng \u1edf m\u1ed9t kh\u1edbp hay v\u00e0i kh\u1edbp kh\u00f4ng chuy\u1ec3n sang c\u00e1c kh\u1edbp kh\u00e1c. + Hay t\u00e1i ph\u00e1t: s\u01b0ng kh\u1edbp t\u00e1i \u0111i t\u00e1i l\u1ea1i nhi\u1ec1u l\u1ea7n \u1edf c\u00f9ng v\u1ecb tr\u00ed. 2. D\u1ecb d\u1ea1ng v\u00e0 bi\u1ebfn d\u1ea1ng – H\u1eadu qu\u1ea3 c\u1ee7a nh\u1eefng bi\u1ebfn \u0111\u1ed5i \u0111\u1ea7u x\u01b0\u01a1ng, d\u00e2y ch\u1eb1ng bao kh\u1edbp l\u00e0m l\u1ec7ch tr\u1ee5c c\u1ee7a kh\u1edbp. – Bi\u1ebfn d\u1ea1ng th\u01b0\u1eddng \u0111i k\u00e8m: hi\u1ec7n t\u01b0\u1ee3ng d\u00ednh, h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng ho\u1eb7c d\u00ednh ho\u00e0n to\u00e0n c\u00e1c kh\u1edbp. – C\u1ed9t s\u1ed1ng bi\u1ebfn d\u1ea1ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn g\u00f9, v\u1eb9o, m\u1ea5t \u0111\u01b0\u1eddng cong sinh l\u00fd (g\u1eb7p trong b\u1ec7nh vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp, tho\u00e1t v\u1ecb \u0111\u0129a \u0111\u1ec7m, tho\u00e1i ho\u00e1 c\u1ed9t s\u1ed1ng v\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh c\u1ed9t s\u1ed1ng kh\u00e1c). – Bi\u1ebfn d\u1ea1ng b\u00e0n tay h\u00ecnh l\u01b0ng d\u0129a, b\u00e0n tay g\u00edo th\u1ed5i g\u1eb7p trong b\u1ec7nh vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p. 3. Thay \u0111\u1ed5i v\u1ec1 \u0111\u1ed9ng t\u00e1c C\u1ea7n so s\u00e1nh 2 b\u00ean ho\u1eb7c so v\u1edbi ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng. Ph\u1ea3i ch\u00fa \u00fd \u0111\u1ebfn t\u1ea5t c\u1ea3 kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp nh\u01b0 g\u1eadp, du\u1ed7i, kh\u00e9p, d\u1ea1ng, xoay…v\u00e0 n\u00ean d\u00f9ng 1 th\u01b0\u1edbc \u0111o g\u00f3c \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng – H\u1ea1n ch\u1ebf \u0111\u1ed9ng t\u00e1c:h\u1ea1n ch\u1ebf ho\u00e0n to\u00e0n trong d\u00ednh kh\u1edbp ho\u00e0n to\u00e0n, h\u1ea1n ch\u1ebf 1 ph\u1ea7n do c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u1edf kh\u1edbp, c\u00e1c ph\u1ea7n m\u1ec1m quanh kh\u1edbp ho\u1eb7c do TK – Kh\u1edbp l\u1ecfng l\u1ebbo: kh\u1edbp v\u0111 v\u1edbi bi\u00ean \u0111\u1ed9 l\u1edbn h\u01a1n b\u00ecnh th\u01b0\u1eddng. C\u00f3 th\u1ec3 l\u00e0 sinh l\u00fd do luy\u1ec7n t\u1eadp, gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1 trong b\u1ec7nh l\u00fd TK, do b\u1ec7nh kh\u1edbp m\u1ea1n t\u00ednh l\u00e0m gi\u00e3n d\u00e2y ch\u1eb1ng v\u00e0 bao kh\u1edbp trong vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p 4. T\u00ecm \u0111i\u1ec3m \u0111au Khi th\u0103m kh\u00e1m kh\u1edbp, c\u1ea7n t\u00ecm \u0111i\u1ec3m \u0111au c\u1ee7a kh\u1edbp, m\u1ed7i kh\u1edbp c\u00f3 1 s\u1ed1 \u0111i\u1ec3m \u0111au \u0111\u1eb7c tr\u01b0ng. C\u1ea7n ph\u00e2n bi\u1ec7t c\u00e1c \u0111i\u1ec3m \u0111au c\u1ee7a c\u00e1c \u0111\u1ea7u g\u00e2n, l\u1ed3i c\u1ea7u n\u1eb1m ngo\u00e0i kh\u1edbp 5. Ph\u00e1t hi\u1ec7n tr\u00e0n d\u1ecbch kh\u1edbp 6. D\u1ea5u hi\u1ec7u kh\u00e1c – C\u1ee5c u quanh kh\u1edbp: c\u1ee5c t\u00f4 phy, h\u1ea1t meynet, h\u1ea1t d\u01b0\u1edbi da – C\u00e1c nang k\u00e9n n\u1ed5i to \u1edf kh\u1edbp do ph\u00ecnh bao ho\u1ea1t d\u1ecbch C\u00e2u 26: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m m\u1ed9t s\u1ed1 kh\u1edbp th\u01b0\u1eddng g\u1eb7p: kh\u1edbp h\u00e1ng, kh\u1edbpg\u1ed1i, kh\u1edbpvai ? * Th\u0103m kh\u00e1m kh\u1edbp h\u00e1ng: B\u1ec7nh l\u00fd kh\u1edbp h\u00e1ng r\u1ea5t phong ph\u00fa, g\u1eb7p \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau nh\u01b0 ch\u1ea5n th\u01b0\u01a1ng, tho\u00e1i h\u00f3a, lo\u1ea1n s\u1ea3n, vi\u00eam. – H\u1ecfi v\u1ec1 c\u00e1c d\u1ea5u hi\u1ec7u c\u01a1 n\u0103ng v\u00e0 ti\u1ec1n s\u1eed: + \u0110au: th\u01b0\u1eddng \u1edf v\u00f9ng b\u1eb9n, c\u00f3 th\u1ec3 \u1edf v\u00f9ng m\u00f4ng, m\u1ea5u chuy\u1ec3n l\u1edbn. \u0110au lan xu\u1ed1ng m\u1eb7t tr\u01b0\u1edbc \u0111\u00f9i, c\u00f3 th\u1ec3 xu\u1ed1ng m\u1eb7t sau v\u00e0 ngo\u00e0i \u0111\u00f9i. + H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng: B\u1ec7nh nh\u00e2n th\u1ea5y kh\u00f3 \u0111\u1ee9ng l\u00e2u, ng\u1ed3i x\u1ed5m b\u1ecb h\u1ea1n ch\u1ebf, b\u01b0\u1edbc l\u00ean b\u1eadc cao g\u00e2y \u0111au. + \u0110i kh\u1eadp kh\u1ec5nh: Xu\u1ea5t hi\u1ec7n s\u1edbm, l\u00fac \u0111\u1ea7u xu\u1ea5t hi\u1ec7n khi \u0111i m\u1ed9t \u0111o\u1ea1n xa. + H\u1ecfi v\u1ec1 ti\u1ec1n s\u1eed: Ch\u00fa \u00fd c\u00e1c ti\u1ec1n s\u1eed v\u1ec1 ch\u1ea5n th\u01b0\u01a1ng, nhi\u1ec5m khu\u1ea9n, c\u00e1c d\u1ecb t\u1eadt b\u1ea9m sinh trong gia \u0111\u00ecnh. – Th\u0103m kh\u00e1m l\u00e2m s\u00e0ng: + Quan s\u00e1t: ++ T\u01b0 th\u1ebf \u0111\u1ee9ng th\u1eb3ng: n\u1ebfu t\u1ed5n th\u01b0\u01a1ng kh\u1edbp h\u00e1ng n\u1eb7ng, s\u1ebd th\u1ea5y b\u1ec7nh nh\u00e2n nghi\u00eang v\u1ec1 b\u00ean l\u00e0nh, c\u00e1c c\u01a1 b\u00ean b\u1ec7nh c\u00f3 th\u1ec3 teo, nh\u1ebdo. ++\u0110\u1ee9ng m\u1ed9t ch\u00e2n (nghi\u1ec7m ph\u00e1p Trendelenburg): v\u00ec \u0111au b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1ee9ng \u0111\u01b0\u1ee3c ch\u00e2n b\u00ean b\u1ec7nh, n\u1ebfu \u0111\u1ee9ng ch\u00e2n b\u00ean b\u1ec7nh th\u00ec khung ch\u1eadu s\u1ebd l\u1ec7ch nghi\u00eang v\u1ec1 ph\u00eda b\u00ean l\u00e0nh. ++ Ng\u1ed3i x\u1ed5m: ch\u00e2n b\u00ean b\u1ec7nh th\u01b0\u1eddng kh\u00f4ng co s\u00e1t v\u00e0o b\u1ee5ng \u0111\u01b0\u1ee3c, n\u1ebfu b\u1ec7nh n\u1eb7ng, b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ng\u1ed3i x\u1ed5m \u0111\u01b0\u1ee3c. ++ D\u00e1ng \u0111i kh\u1eadp kh\u1ec5nh: c\u1ee7a t\u1ed5n th\u01b0\u01a1ng kh\u1edbp h\u00e1ng, khi b\u01b0\u1edbc l\u00ean b\u1eadc thang ch\u00e2n b\u00ean b\u1ec7nh nh\u1ea5c l\u00ean ch\u1eadm v\u00e0 kh\u00f3. + S\u1edd n\u1eafn: t\u00ecm c\u00e1c \u0111i\u1ec3m \u0111au, t\u00ecm h\u1ea1ch to v\u00e0 kh\u00e1m c\u00e1c c\u01a1 quanh kh\u1edbp + Kh\u00e1m c\u00e1c \u0111\u1ed9ng t\u00e1c: l\u00e0 kh\u00e2u quan tr\u1ecdng nh\u1ea5t, kh\u00e1m \u1edf c\u00e1c t\u01b0 th\u1ebf \u0111\u1ee9ng, n\u1eb1m ng\u1eeda v\u00e0 n\u1eb1m s\u1ea5p, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng th\u01b0\u1edbc \u0111o g\u00f3c \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng c\u1ee5 th\u1ec3 ++ Y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n th\u1ef1c hi\u1ec7n m\u1ed9t s\u1ed1 \u0111\u1ed9ng t\u00e1c c\u00f3 t\u00ednh ch\u1ea5t t\u1ed5ng h\u1ee3p \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u01a1 b\u1ed9: c\u00fai ng\u01b0\u1eddi ra tr\u01b0\u1edbc, gi\u1ea1ng 2 ch\u00e2n, ng\u1ed3i x\u1ed5m ++ L\u1ea7n l\u01b0\u1ee3t kh\u00e1m c\u00e1c \u0111\u1ed9ng t\u00e1c:g\u1ea5p, du\u1ed7i, kh\u00e9p, gi\u1ea1ng v\u00e0 quay. Th\u01b0\u1eddng kh\u00e1m v\u1edbi t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda. C\u00e1c g\u00f3c ho\u1ea1t \u0111\u1ed9ng c\u1ee7a kh\u1edbp h\u00e1ng b\u00ecnh th\u01b0\u1eddng: G\u1ea5p ch\u00e2n du\u1ed7i: 90 \u0111\u1ed9, g\u1ea5p ch\u00e2n g\u1ea5p: 120 \u0111\u1ed9, Du\u1ed7i c\u1ed1: 30 \u0111\u1ed9, Kh\u00e9p: 35 \u0111\u1ed9, Gi\u1ea1ng v\u1edbi ch\u00e2n du\u1ed7i th\u1eb3ng: 45 \u0111\u1ed9, Gi\u1ea1ng v\u1edbi ch\u00e2n g\u1ea5p: 90 \u0111\u1ed9, Quay ra: 40 \u0111\u1ed9, quay v\u00e0o: 45 \u0111\u1ed9 * Kh\u00e1m kh\u1edbp g\u1ed1i: B\u1ec7nh l\u00fd kh\u1edbp g\u1ed1i r\u1ea5t phong ph\u00fa, \u0111a d\u1ea1ng v\u00e0 th\u01b0\u1eddng g\u1eb7p trong l\u00e2m s\u00e0ng. – H\u1ecfi b\u1ec7nh: + \u0110au: ch\u00fa \u00fd khai th\u00e1c v\u1ecb tr\u00ed v\u00e0 t\u00ednh ch\u1ea5t c\u1ee7a \u0111au. \u0110au do vi\u00eam th\u00ec li\u00ean t\u1ee5c v\u00e0 t\u0103ng v\u1ec1 \u0111\u00eam. \u0110au c\u01a1 gi\u1edbi (tho\u00e1i h\u00f3a) t\u0103ng khi v\u1eadn \u0111\u1ed9ng, khi l\u00ean ho\u1eb7c xu\u1ed1ng c\u1ea7u thang v\u00e0 gi\u1ea3m \u0111au khi ngh\u1ec9 ng\u01a1i, C\u1ea7n ph\u00e2n bi\u1ec7t \u0111au x\u01b0\u01a1ng ch\u00e0y ho\u1eb7c \u0111au x\u01b0\u01a1ng \u0111\u00f9i v\u1edbi \u0111au kh\u1edbp g\u1ed1i + H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng: th\u1ec3 hi\u1ec7n b\u1eb1ng c\u00e1c \u0111\u1ed9ng t\u00e1c \u0111i, \u0111\u1ee9ng, ng\u1ed3i xu\u1ed1ng v\u00e0 \u0111\u1ee9ng l\u00ean, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 d\u1ea5u hi\u1ec7u ph\u00e1 g\u1ec9 kh\u1edbp. + Ti\u1ebfng l\u1ea1o x\u1ea1o khi v\u1eadn \u0111\u1ed9ng: \u00edt gi\u00e1 tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n + Ch\u00fa \u00fd khai th\u00e1c ti\u1ec1n s\u1eed b\u1ec7nh: ch\u1ea5n th\u01b0\u01a1ng, b\u1ec7nh v\u1ec1 m\u00e1u, b\u1ec7nh kh\u1edbp tr\u01b0\u1edbc \u0111\u00e2y. – Quan s\u00e1t: Quan s\u00e1t nh\u1eefng thay \u0111\u1ed5i v\u1ec1 da, ph\u1ea7n m\u1ec1m v\u00e0 h\u00ecnh th\u00e1i kh\u1edbp g\u1ed1i: s\u01b0ng \u0111\u1ecf t\u1ea5y trong vi\u00eam kh\u1edbp m\u1ee7, th\u1ea5p kh\u1edbp c\u1ea5p; s\u01b0ng to c\u0103ng trong tr\u00e0n d\u1ecbch kh\u1edbp g\u1ed1i; n\u1ed5i u ph\u00ecnh to \u1edf tr\u01b0\u1edbc x\u01b0\u01a1ng b\u00e1nh ch\u00e8, \u1edf v\u00f9ng kheo do c\u00e1c k\u00e9n ho\u1ea1t d\u1ecbch tho\u00e1t ra ; m\u1ecdc c\u00e1c u c\u1ee5c quanh kh\u1edbp trong b\u1ec7nh gout, m\u1ecdc gai x\u01b0\u01a1ng trong tho\u00e1i ho\u00e1. Quan s\u00e1t hi\u1ec7n t\u01b0\u1ee3ng teo c\u01a1 quanh kh\u1edbp. T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n \u0111\u1ee9ng th\u1eb3ng: ph\u00e1t hi\u1ec7n c\u00e1c d\u1ecb d\u1ea1ng kh\u1edbp g\u1ed1i v\u00e0 x\u01b0\u01a1ng. T\u1eadt kh\u1edbp g\u1ed1i l\u1ec7ch v\u00e0o trong, ra ngo\u00e0i; x\u01b0\u01a1ng ch\u00e0y bi\u1ebfn d\u1ea1ng trong b\u1ec7nh c\u00f2i x\u01b0\u01a1ng. – S\u1edd n\u1eafn: +T\u00ecm c\u00e1c \u0111i\u1ec3m \u0111au: l\u1ed3i c\u1ea7u c\u1ee7a x\u01b0\u01a1ng ch\u00e0y v\u00e0 x\u01b0\u01a1ng \u0111\u00f9i + Di \u0111\u1ed9ng x\u01b0\u01a1ng b\u00e1nh ch\u00e8: b\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda, ch\u00e2n du\u1ed7i th\u1eb3ng, d\u00f9ng c\u00e1c ng\u00f3n tay n\u1eafm x\u01b0\u01a1ng b\u00e1nh ch\u00e8 t\u1eeb 3 ph\u00eda, r\u1ed3i di \u0111\u1ed9ng sang hai b\u00ean v\u00e0 di \u0111\u1ed9ng d\u1ecdc theo tr\u1ee5c ch\u00e2n, n\u1ebfu c\u00f3 tho\u00e1i ho\u00e1 kh\u1edbp g\u1ed1i b\u1ec7nh nh\u00e2n s\u1ebd th\u1ea5y \u0111au v\u00e0 c\u1ea3m gi\u00e1c l\u1ea1o x\u1ea1o khi di \u0111\u1ed9ng (d\u1ea5u hi\u1ec7u b\u00e0o g\u1ed7) + B\u1eadp b\u1ec1nh x\u01b0\u01a1ng b\u00e1nh ch\u00e8 v\u00e0 d\u1ea5u ba \u0111\u1ed9ng: Khi kh\u1edbp g\u1ed1i c\u00f3 nhi\u1ec1u d\u1ecbch s\u1ebd c\u00f3 hai d\u1ea5u hi\u1ec7u n\u00e0y. B\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda, ch\u00e2n du\u1ed7i th\u1eb3ng, th\u1ea7y thu\u1ed1c d\u00f9ng 5 ng\u00f3n tay \u0111\u1eb7t l\u00ean x\u01b0\u01a1ng b\u00e1nh ch\u00e8, ng\u00f3n tay tr\u1ecf ngay tr\u00ean m\u1eb7t x\u01b0\u01a1ng, ng\u00f3n c\u00e1i v\u00e0 ng\u00f3n 3 \u0111\u1ec3 hai b\u00ean b\u1edd ngo\u00e0i v\u00e0 b\u1edd trong x\u01b0\u01a1ng b\u00e1nh ch\u00e8, khi ng\u00f3n tr\u1ecf \u1ea5n nh\u1eb9 xu\u1ed1ng, ta c\u00f3 c\u1ea3m gi\u00e1c x\u01b0\u01a1ng b\u00e1nh ch\u00e8 ch\u1ea1m nh\u1eb9 v\u00e0o x\u01b0\u01a1ng ph\u00eda d\u01b0\u1edbi v\u00e0 n\u01b0\u1edbc d\u1ed3n ra xung quanh (d\u1ea5u hi\u1ec7u b\u1eadp b\u1ec1nh x\u01b0\u01a1ng b\u00e1nh ch\u00e8 hay ch\u1ea1m x\u01b0\u01a1ng b\u00e1nh ch\u00e8) n\u1ebfu l\u01b0\u1ee3ng n\u01b0\u1edbc nhi\u1ec1u, ta g\u00f5 nh\u1eb9 ng\u00f3n tay 3 s\u1ebd th\u1ea5y c\u00f3 c\u1ea3m gi\u00e1c n\u01b0\u1edbc d\u1ed9i v\u00e0ong\u00f3n c\u00e1i (d\u1ea5u hi\u1ec7u ba \u0111\u1ed9ng). + D\u1ea5u hi\u1ec7u r\u00fat ng\u0103n k\u00e9o: B\u1ec7nh nh\u00e2n ng\u1ed3i, c\u1eb3ng ch\u00e2n vu\u00f4ng g\u00f3c v\u1edbi \u0111\u00f9i ch\u00e2n. Tay tr\u00e1i th\u1ea7y thu\u1ed1c c\u1ed1 \u0111\u1ecbnh ph\u00eda d\u01b0\u1edbi \u0111\u00f9i ch\u00e2n, tay ph\u1ea3i th\u1ea7y thu\u1ed1c n\u1eafm ch\u00e2nb\u1ec7nh nh\u00e2n ngay ph\u1ea7n tr\u00ean c\u1eb3ng ch\u00e2n, k\u00e9o c\u1eb3ng ch\u00e2n b\u1ec7nh nh\u00e2n v\u1ec1 ph\u00eda th\u1ea7y thu\u1ed1c. B\u00ecnh th\u01b0\u1eddng c\u00e1c d\u00e2y ch\u1eb1ng gi\u1eef \u0111\u01b0\u1ee3c kh\u1edbp g\u1ed1i t\u1ed1t n\u00ean ta kh\u00f4ng k\u00e9o ra \u0111\u01b0\u1ee3c, n\u1ebfu k\u00e9o ra \u0111\u01b0\u1ee3c ch\u00fat \u00edt g\u1ecdi l\u00e0 kh\u1edbp l\u1ecfng l\u1ebbo. – Kh\u00e1m c\u00e1c \u0111\u1ed9ng t\u00e1c: y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n l\u00e0m c\u00e1c \u0111\u1ed9ng t\u00e1c g\u1ea5p, du\u1ed7i kh\u1edbp g\u1ed1i ch\u1ee7 \u0111\u1ed9ng v\u00e0 th\u1ee5 \u0111\u1ed9ng. Khi kh\u1edbp g\u1ed1i t\u1ed5n th\u01b0\u01a1ng, ho\u1ea1t \u0111\u1ed9ng g\u1ea5p du\u1ed7i s\u1ebd h\u1ea1n ch\u1ebf. Ng\u01b0\u1ee3c l\u1ea1i khi c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng d\u00e3n d\u00e2y ch\u1eb1ng s\u1ebd c\u00f3 d\u1ea5u hi\u1ec7u kh\u1edbp l\u1ecfng l\u1ebbo \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n b\u1eb1ng d\u1ea5u r\u00fat ng\u0103n k\u00e9o v\u00e0 l\u00fac l\u1eafc c\u1eb3ng ch\u00e2n * Kh\u00e1m kh\u1edbp vai: Kh\u1edbp vai c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m nhi\u1ec1u \u0111\u1ed9ng t\u00e1c nh\u1ea5t trong c\u01a1 th\u1ec3. Kh\u1edbp vai c\u00f3 m\u1ed9t bao kh\u1edbp r\u1ea5t r\u1ed9ng v\u00e0 l\u1ecfng l\u1ebbo. S\u1ef1 v\u1eadn \u0111\u1ed9ng kh\u1edbp vai c\u00f3 s\u1ef1 tham gia c\u1ee7a 3 kh\u1edbp x\u01b0\u01a1ng v\u00e0 2 kh\u1edbp x\u01b0\u01a1ng c\u01a1: kh\u1edbp c\u00e1nh tay- b\u1ea3; kh\u1edbp b\u1ea3- l\u1ed3ng ng\u1ef1c; kh\u1edbp \u0111\u00f2n- b\u1ea3; kh\u1edbp c\u01a1 delta- c\u00e1nh tay v\u00e0 kh\u1edbp \u1ee9c \u0111\u00f2n. Kh\u1edbp vai \u0111\u01b0\u1ee3c t\u0103ng c\u01b0\u1eddng b\u1edfi nhi\u1ec1u g\u00e2n, d\u00e2y ch\u1eb1ng v\u00e0 c\u00f3 nhi\u1ec1u m\u1ed1i li\u00ean quan \u0111\u1ebfn \u0111\u00e1m r\u1ed1i th\u1ea7n kinh c\u00e1nh tay, chu\u1ed7i h\u1ea1ch giao c\u1ea3m c\u1ed5, \u0111\u1ec9nh ph\u1ed5i, c\u1ed9t s\u1ed1ng c\u1ed5. B\u1ec7nh l\u00fd c\u1ee7a kh\u1edbp vai ph\u1ea7n l\u1edbn do nh\u1eefng t\u1ed5n th\u01b0\u01a1ng c\u1ee7a ph\u1ea7n m\u1ec1m quanh kh\u1edbp; nh\u1eefng th\u01b0\u01a1ng t\u1ed5n th\u1ef1c s\u1ef1 c\u1ee7a kh\u1edbp vai r\u1ea5t \u00edt g\u1eb7p. – H\u1ecfi b\u1ec7nh: + \u0110au: Kh\u1edbp vai c\u00f3 bi\u1ec3u hi\u1ec7n \u0111au \u1edf nhi\u1ec1u v\u1ecb tr\u00ed: m\u1ecfm vai, v\u00f9ng x\u01b0\u01a1ng b\u1ea3, kh\u1edbp \u1ee9c \u0111\u00f2n,H\u01b0\u1edbng lan c\u1ee7a \u0111au c\u00f3 th\u1ec3 \u0111i xu\u1ed1ng c\u00e1nh tay, l\u00ean g\u00e1y v\u00e0 v\u00f9ng ch\u1ea9m, \u0111au nhi\u1ec1u v\u1ec1 \u0111\u00eam. + H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp vai: b\u1ec7nh nh\u00e2n kh\u00f3 l\u00e0m m\u1ed9t s\u1ed1 \u0111\u1ed9ng t\u00e1c nh\u01b0 ch\u1ea3i \u0111\u1ea7u, g\u00e3i l\u01b0ng, gi\u01a1 tay. + H\u1ecfi ti\u1ec1n s\u1eed. – S\u1edd n\u1eafn: t\u00ecm tri\u1ec7u ch\u1ee9ng n\u00f3ng c\u1ee7a d\u1ea5u hi\u1ec7u vi\u00eam kh\u1edbp, vi\u00eam c\u01a1 v\u00f9ng vai. – Kh\u00e1m c\u00e1c \u0111\u1ed9ng t\u00e1c c\u1ee7a kh\u1edbp vai: kh\u00e1m c\u00e1c \u0111\u1ed9ng t\u00e1c ch\u1ee7 \u0111\u1ed9ng v\u00e0 th\u1ee5 \u0111\u1ed9ng c\u1ee7a kh\u1edbp vai g\u1ed3m: +Gi\u01a1 tay ra tr\u01b0\u1edbc, ra sau, l\u00ean tr\u00ean +Kh\u00e9p tay v\u00e0o, gi\u1ea1ng tay ra, l\u00ean tr\u00ean +Nh\u00fan vai l\u00ean, h\u1ea1 vai xu\u1ed1ng, \u0111\u01b0a ra tr\u01b0\u1edbc v\u00e0 ra sau. +Quay v\u00f2ng tr\u00f2n. – Kh\u00e1m c\u00e1c b\u1ed9 ph\u1eadn li\u00ean quan +Teo c\u01a1 v\u00f9ng b\u1ea3 vai v\u00e0 c\u00e1nh tay g\u1eb7p trong vi\u00eam kh\u1edbp vai k\u00e9o d\u00e0i. +R\u1ed1i lo\u1ea1n v\u1eadn m\u1ea1ch b\u00e0n tay: ph\u00f9 n\u1ec1, teo \u0111\u00e9t, co. . trong h\u1ed9i ch\u1ee9ng vai g\u00e1y. + C\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u1ed9t s\u1ed1ng c\u1ed5, c\u00e1c n\u1ed9i t\u1ea1ng \u1edf trong l\u1ed3ng ng\u1ef1c c\u00f3 th\u1ec3 c\u00f3 li\u00ean quan \u0111\u1ebfn kh\u1edbp vai (h\u1ed9i ch\u1ee9ng \u0111au vai do h\u01b0 c\u1ed9t s\u1ed1ng c\u1ed5, do ung th\u01b0 ph\u1ebf qu\u1ea3n, nh\u1ed3i m\u00e1u c\u01a1 tim) C\u00e2u 27: Tr\u00ecnh b\u00e0y c\u00e1ch ph\u00e2n khu v\u00f9ng b\u1ee5ng( c\u00f3 h\u00ecnh v\u1ebd, v\u00e0 t\u00ean c\u00e1c v\u00f9ng) ? H\u00ecnh chi\u1ebfu c\u1ee7a c\u00e1c t\u1ea1ng l\u00ean t\u1eebng v\u00f9ng ? I. Ph\u00e2n khu v\u00f9ng b\u1ee5ng: – K\u1ebb 2 \u0111\u01b0\u1eddng ngang: \u0110\u01b0\u1eddng tr\u00ean qua \u0111i\u1ec3m th\u1ea5p nh\u1ea5t c\u1ee7a 2 x\u01b0\u01a1ng s\u01b0\u1eddn. \u0110\u01b0\u1eddng d\u01b0\u1edbi qua 2 gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean. – K\u1ebb 2 \u0111\u01b0\u1eddg d\u1ecdc \u1ed5 b\u1ee5ng:Qua gi\u1eefa b\u1edd s\u01b0\u1eddn v\u00e0 cung \u0111\u00f9i (m\u1ed7i b\u00ean 1 \u0111\u01b0\u1eddng) B\u1ed1n \u0111\u01b0\u1eddng k\u1ebb n\u00e0y chia \u1ed5 b\u1ee5ng th\u00e0nh 9 v\u00f9ng: 1: V\u00f9ng th\u01b0\u1ee3ng v\u1ecb 2: V\u00f9ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i 3: Vung h\u1ea1 s\u01b0\u1eddn tr\u00e1i 4: V\u00f9ng r\u1ed1n 5: V\u00f9ng m\u1ea1ng m\u1ee1 ph\u1ea3i 6: V\u00f9ng m\u1ea1ng m\u1ee1 tr\u00e1i 7: V\u00f9ng h\u1ea1 v\u1ecb 8: V\u00f9ng h\u1ed1 ch\u1eadu ph\u1ea3i 9: V\u00f9ng h\u1ed1 ch\u1eadu tr\u00e1i [\u200bIMG] 2 1 3 54 6 8 7 9 II. H\u00ecnh chi\u1ebfu c\u1ee7a c\u00e1c c\u01a1 quan trong \u1ed5 b\u1ee5ng l\u00ean t\u1eebng v\u00f9ng: 1.V\u00f9ng th\u01b0\u1ee3ng v\u1ecb: Thu\u1ef3 gan tr\u00e1i, Ph\u1ea7n l\u1edbn d\u1ea1 d\u00e0y k\u1ec3 c\u1ea3 t\u00e2m v\u1ecb v\u00e0 m\u00f4n v\u1ecb, M\u1ea1c n\u1ed1i gan- d\u1ea1 d\u00e0y trong \u0111\u00f3 c\u00f3 m\u1ea1ch m\u00e1u v\u00e0 \u1ed1ng m\u1eadt.T\u00e1 tr\u00e0ng, tu\u1ef5 t\u1ea1ng. \u0110\u00e1m r\u1ed1i th\u00e1i d\u01b0\u01a1ng, \u0110\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng,\u0111\u1ed9ng m\u1ea1ch th\u00e2n t\u1ea1ng,T\u0129nh m\u1ea1ch ch\u1ee7 b\u1ee5ng, H\u1ec7 th\u1ed1ng h\u1ea1ch b\u1ea1ch huy\u1ebft. 2.V\u00f9ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i: Thu\u1ef3 gan ph\u1ea3i, T\u00fai m\u1eadt, G\u00f3c \u0111\u1ea1i tr\u00e0ng ph\u1ea3i, Tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn ph\u1ea3i, C\u1ef1c tr\u00ean th\u1eadn ph\u1ea3i. 3.V\u00f9ng h\u1ea1 s\u01b0\u1eddn tr\u00e1i: L\u00e1ch,\u0111u\u00f4i tu\u1ef5, M\u1ed9t ph\u1ea7n d\u1ea1 d\u00e0y , G\u00f3c \u0111\u1ea1i tr\u00e0ng tr\u00e1i, Tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn tr\u00e1i, C\u1ef1c tr\u00ean th\u1eadn tr\u00e1i 4.V\u00f9ng r\u1ed1n: M\u1ea1c n\u1ed1i l\u1edbn (kh\u00f4ng ch\u1ec9 v\u00f9ng n\u00e0y m\u00e0 lan to\u1ea3 nhi\u1ec1u v\u00f9ng trong \u1ed5 b\u1ee5ng), \u0110\u1ea1i tr\u00e0ng ngang, Ru\u1ed9t non, M\u1ea1c treo ru\u1ed9t non (trong \u0111\u00f3 c\u00f3 m\u1ea1ch m\u00e1u c\u1ee7a ru\u1ed9t), H\u1ec7 th\u1ed1ng h\u1ea1ch m\u1ea1c treo v\u00e0 c\u00e1c h\u1ea1ch ngo\u00e0i m\u1ea1c treo, \u0110\u1ed9ng m\u1ea1chch\u1ee7 b\u1ee5ng,\u0111\u1ed9ng m\u1ea1ch th\u1eadn 2 b\u00ean.T\u0129nh m\u1ea1ch ch\u1ee7 b\u1ee5ng. 5.V\u00f9ng m\u1ea1ng m\u1ee1 ph\u1ea3i: \u0110\u1ea1i tr\u00e0ng l\u00ean, Ru\u1ed9t non, Th\u1eadn ph\u1ea3i 6.V\u00f9ng m\u1ea1ng m\u1ee1 tr\u00e1i: \u0110\u1ea1i tr\u00e0ng xu\u1ed1ng, Ru\u1ed9t non, Th\u1eadn tr\u00e1i 7.V\u00f9ng h\u1ea1 v\u1ecb Ru\u1ed9t non, Tr\u1ef1c tr\u00e0ng v\u00e0 \u0111\u1ea1i tr\u00e0ng sigma, B\u00e0ng quang, \u0110o\u1ea1n cu\u1ed1i ni\u1ec7u qu\u1ea3n, \u1ede PN c\u00f3 t\u1eed cung,2 v\u00f2i tr\u1ee9ng, d\u00e2y ch\u1eb1ng r\u1ed9ng,d\u00e2y ch\u1eb1ng tr\u00f2n, \u0111\u1ed9ng t\u0129nh m\u1ea1ch t\u1eed cung. 8.V\u00f9ng h\u1ed1 ch\u1eadu ph\u1ea3i: Manh tr\u00e0ng, Ru\u1ed9t non (c\/y\u1ebfu l\u00e0 \u0111o\u1ea1n R cu\u1ed1i), Ru\u1ed9t th\u1eeba, Bu\u1ed3ng tr\u1ee9ng ph\u1ea3i, \u0110\/m ch\u1eadu g\u00f3c ph\u1ea3i, H\u1ec7 th\u1ed1ng h\u1ea1ch b\u1ea1ch huy\u1ebft, M\u1ed9t ph\u1ea7n c\u01a1 \u0111\u00e1y ch\u1eadu 9.V\u00f9ng h\u1ed1 ch\u1eadu tr\u00e1i: \u0110\u1ea1i tr\u00e0ng sigma, Ru\u1ed9t non (\u0110o\u1ea1n c\u00f3 t\u00fai th\u1eeba meckel), Bu\u1ed3ng tr\u1ee9ng tr\u00e1i, \u0110\/m ch\u1eadu g\u00f3c tr\u00e1i, T\/m ch\u1eadu g\u00f3c tr\u00e1i, H\u1ec7 th\u1ed1ng h\u1ea1ch b\u1ea1ch huy\u1ebft, M\u1ed9t ph\u1ea7n c\u01a1 \u0111\u00e1y ch\u1eadu S\u1ef1 ph\u00e2n khu tr\u00ean \u0111\u00e2y ch\u1ec9 l\u00e0 t\u01b0\u01a1ng \u0111\u1ed1i v\u00ec v\u1ecb tr\u00ed m\u1ed9t s\u1ed1 n\u1ed9i t\u1ea1ng c\u00f3 th\u1ec3 thay \u0111\u1ed5i b\u1ea9m sinh or m\u1eafc ph\u1ea3i. C\u00e2u 28: Tr\u00ecnh b\u00e0y kh\u00e1m b\u1ee5ng b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p nh\u00ecn? Nh\u1eefng thay \u0111\u1ed5i b\u1ec7nh l\u00fd? – Nguy\u00ean t\u1eafc chung: . T\u01b0 th\u1ebf ng\u01b0\u1eddi b\u1ec7nh: n\u1eb1m tr\u00ean gi\u01b0\u1eddng, hai tay du\u1ed7i th\u1eb3ng hai b\u00ean ng\u01b0\u1eddi, haich\u00e2n h\u01a1i co \u0111\u1ec3 l\u00e0m cho m\u1ec1m th\u00e0nh b\u1ee5ng. Ph\u1ea3i n\u1eb1m c\u00e2n \u0111\u1ed1i ngay ng\u1eafn, kh\u00f4ng n\u00ean g\u1ed1i \u0111\u1ea7u cao qu\u00e1. .T\u01b0 th\u1ebf th\u1ea7y thu\u1ed1c: ng\u1ed3i ho\u1eb7c \u0111\u1ee9ng b\u00ean ph\u1ea3i ng\u01b0\u1eddi b\u1ec7nh. – Ph\u00f2ng kh\u00e1m: \u0111\u1ee7 \u00e1nh s\u00e1ng, k\u00edn \u0111\u00e1o, \u0111\u1ee7 \u1ea5m, \u0111\u1ee7 d\u1ee5ng c\u1ee5 kh\u00e1m k\u1ec3 c\u1ea3 g\u0103ng tay cao su. – C\u00e1ch kh\u00e1m: Ph\u1ea3i b\u1ed9c l\u1ed9 h\u1ebft v\u00f9ng b\u1ee5ng; ph\u1ea3i kh\u00e1m \u0111\u1ee7 nh\u00ecn, s\u1edd, g\u00f5, nghe v\u00e0 cu\u1ed1i c\u00f9ng l\u00e0 th\u0103m tr\u1ef1c tr\u00e0ng n\u1ebfu c\u1ea7n thi\u1ebft. + Nh\u00ecn: b\u00ecnh th\u01b0\u1eddng th\u00e0nh b\u1ee5ng ngang x\u01b0\u01a1ng \u1ee9c, c\u1eed \u0111\u1ed9ng nh\u1ecbp nh\u00e0ng theo nh\u1ecbp th\u1edf, r\u1ed1n l\u00f5m. Ng\u01b0\u1eddi b\u00e9o ho\u1eb7c ph\u1ee5 n\u1eef \u0111\u1ebb nhi\u1ec1u b\u1ee5ng b\u00e8 ra 2 b\u00ean, tr\u00ean da c\u00f3 v\u1ebft r\u1ea1n n\u1ebfu \u0111\u00e3 \u0111\u1ebb. ++ Quan s\u00e1t b\u1ee5ng t\u00ecm nh\u1eefng thay \u0111\u1ed5i v\u1ec1 h\u00ecnh th\u00e1i: b\u1ee5ng l\u00f5m l\u00f2ng thuy\u1ec1n, b\u1ee5ng tr\u01b0\u1edbng, r\u1ed1n l\u1ed3i. ++ Quan s\u00e1t t\u00ecm nh\u1eefng thay \u0111\u1ed5i v\u1ec1 c\u1eed \u0111\u1ed9ng th\u00e0nh b\u1ee5ng: th\u00e0nh b\u1ee5ng co c\u1ee9ngkh\u00f4ng c\u1eed \u0111\u1ed9ng theo nh\u1ecbp th\u1edf g\u1eb7p trong vi\u00eam ph\u00fac m\u1ea1c, ho\u1eb7c do \u0111au qu\u00e1.th\u00e0nh b\u1ee5ng khi ch\u01b0\u1edbng c\u0103ng qu\u00e1 c\u0169ng kh\u00f4ng c\u1eed \u0111\u1ed9ng theo nh\u1ecbp th\u1edf \u0111\u01b0\u1ee3c ++ Quan s\u00e1t t\u00ecm d\u1ea5u hi\u1ec7u r\u1eafn b\u00f2: c\u00f3 th\u1ec3 th\u1ea5y \u1edf to\u00e0n \u1ed5 b\u1ee5ng hay ch\u1ec9 \u1edf m\u1ed9t v\u00f9ng,g\u1eb7p trong h\u1eb9p m\u00f4n v\u1ecb, t\u1eafc \u0111\u1ea1i tr\u00e0ng, t\u1eafc ru\u1ed9t non. ++ Quan s\u00e1t tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7: c\u1ea7n ph\u00e2n bi\u1ec7t tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 v\u1edbi tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi g\u1ea7y, c\u00f3 th\u1ec3 th\u1ea5y m\u1ed9t s\u1ed1 m\u1ea1ch m\u00e1u l\u1ed9 r\u00f5 h\u01a1n v\u00ec m\u1ea5t l\u1edbp m\u1ee1 da b\u1ee5ng. C\u00e2u 29: Tr\u00ecnh b\u00e0y c\u00e1ch h\u1ecfi 1 b\u1ec7nh nh\u00e2n b\u1ecb \u0111au b\u1ee5ng? 1. H\u1ecfi v\u1ec1 c\u01a1n \u0111au:L\u00e0 tri\u1ec7u ch\u1ee9ng ch\u1ec9 \u0111i\u1ec3m cho 1 t\u1ed5n th\u01b0\u01a1ng th\u1ef1c th\u1ec3. C\u1ea7n h\u1ecfi k\u1ef9 v\u1ec1: – Ho\u00e0n c\u1ea3nh xu\u1ea5t hi\u1ec7n(Y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t): \u0111au sau 1 b\u1eefa \u0103n d\u1ea7u m\u1ee1 trong c\u01a1n \u0111au qu\u1eb7n gan, sau v\u1eadn \u0111\u1ed9ng nhi\u1ec1u trong c\u01a1n \u0111au qu\u1eb7n th\u1eadn – T\u00ednh ch\u1ea5t kh\u1ecfi ph\u00e1t: kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t trong c\u01a1n \u0111au b\u1ee5ng c\u1ea5p do vi\u00eam t\u1ee5y c\u1ea5p, giun chui \u1ed1ng m\u1eadt, hay t\u1eeb t\u1eeb trong c\u01a1n \u0111au c\u1ee7a lo\u00e9t d\u1ea1 d\u00e0y – V\u1ecb tr\u00ed \u0111au: \u0111\u1ea7u ti\u00ean \u0111au \u1edf \u0111\u00e2u. C\u00f3 gi\u00e1 tr\u1ecb quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n. Vd: \u0111au v\u00f9ng th\u01b0\u1ee3ng v\u1ecb trong vi\u00eam d\u1ea1 d\u00e0y, lo\u00e9t d\u1ea1 d\u00e0y.. – H\u01b0\u1edbng lan:lan l\u00ean vai ph\u1ea3i trong c\u01a1n \u0111au qu\u1eb7n gan, lan xu\u1ed1ng \u0111\u00f9i, b\u1ed9 ph\u1eadn sinh d\u1ee5c trong c\u01a1n \u0111au qu\u1eb7n th\u1eadn – T\u00ednh ch\u1ea5t \u0111au (C\u1ea3m gi\u00e1c \u0111au): \u0111au t\u1ee9c trong tr\u01b0\u1eddng h\u1ee3p c\u0103ng do c\u01a1 h\u1ecdc nh\u01b0 s\u1ecfi m\u1eadt hay giun chui \u1ed1ng m\u1eadt. \u0110au n\u00f3ng r\u00e1t trong vi\u00eam d\u1ea1 d\u00e0y. \u0110au nh\u00f3i trong lo\u00e9t h\u00e0nh t\u00e1 tr\u00e0ng. \u0110au nh\u01b0 dao \u0111\u00e2m trong th\u1ee7ng d\u1ea1 d\u00e0y… – Y\u1ebfu t\u1ed1 l\u00e0m d\u1ecbu hay l\u00e0m t\u0103ng \u0111au: nh\u01b0 v\u1eadn \u0111\u1ed9ng, \u0103n u\u1ed1ng, thu\u1ed1c men… – Di\u1ec5n ti\u1ebfn c\u1ee7a c\u01a1n \u0111au: \u0111au t\u1eebng c\u01a1n trong nguy\u00ean nh\u00e2n do s\u1ecfi hay giun chui \u1ed1ng m\u1eadt, \u0111au li\u00ean t\u1ee5c trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p do vi\u00eam nh\u01b0 vi\u00eam t\u1ee5y c\u1ea5p, vi\u00eam d\u1ea1 d\u00e0y c\u1ea5p. \u0110au c\u00f3 t\u00ednh ch\u1ea5t chu k\u1ef3, theo nh\u1ecbp trong ng\u00e0y, trong n\u0103m nh\u01b0 lo\u00e9t d\u1ea1 d\u00e0y hay t\u00e1 tr\u00e0ng – C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111i k\u00e8m:Ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c bi\u1ec3u hi\u1ec7n: + D\u1ea5u t\u1ea1i ch\u1ed7 (d\u1ea5u li\u00ean quan \u0111\u1ebfn b\u1ed9 ph\u1eadn c\u00f3 b\u1ec7nh) : n\u00f4n m\u1eeda, r\u1ed1i lo\u1ea1n \u0111\u1ea1i ti\u1ec7n, \u0111\u00e1i m\u00e1u + C\u00e1c bi\u1ec3u hi\u1ec7n to\u00e0n th\u00e2n: s\u1ed1t, ng\u1ea5t 2. H\u1ecfi v\u1ec1 ti\u1ec1n s\u1eed – Ch\u00fa \u00fd \u0111\u1ebfn t\u00ednh ch\u1ea5t t\u00e1i ph\u00e1t nhi\u1ec1u l\u1ea7n c\u1ee7a c\u00e1c c\u01a1n \u0111au gi\u1ed1ng nhau nh\u01b0 trong lo\u00e9t d\u1ea1 d\u00e0y, s\u1ecfi m\u1eadt… – Ngh\u1ec1 nghi\u1ec7p: c\u00f3 th\u1ec3 c\u00f3 li\u00ean quan, v\u00ed d\u1ee5 c\u01a1n \u0111au b\u1ee5ng ch\u00ec do ng\u1ed9 \u0111\u1ed9c ch\u1ec9 \u1edf nh\u1eefng ng\u01b0\u1eddi hay ti\u1ebfp x\u00fac v\u1edbi ch\u1ea5t n\u00e0y – C\u00e1c th\u00f3i quen c\u00f3 th\u1ec3 c\u00f3 h\u1ea1i nh\u01b0 u\u1ed1ng r\u01b0\u1ee3u nhi\u1ec1u C\u00e2u 30:Tr\u00ecnh b\u00e0y c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y \u0111au b\u1ee5ng c\u1ea5p v\u00f9ng h\u1ed1 ch\u1eadu v\u00e0 b\u1ee5ng d\u01b0\u1edbi. \u0110au \u1edf v\u00f9ng th\u01b0\u1ee3ng v\u1ecb v\u00e0 ph\u1ea7n b\u1ee5ng tr\u00ean? 1. Nguy\u00ean nh\u00e2n g\u00e2y \u0111au b\u1ee5ng c\u1ea5p v\u00f9ng h\u1ed1 ch\u1eadu v\u00e0 b\u1ee5ng d\u01b0\u1edbi: – \u0110au b\u1ee5ng n\u1ed9i khoa: + \u0110au b\u1ee5ng kinh (c\u00f3 th\u1ed1ng kinh): th\u01b0\u1eddng x\u1ea3y ra \u1edf ph\u1ee5 n\u1eef tr\u1ebb, c\u00f2n kinh nguy\u1ec7t, c\u01a1n \u0111au c\u00f3 li\u00ean h\u1ec7 \u0111\u1ebfn chu k\u1ef3 kinh, \u0111au 2 b\u00ean h\u1ed1 ch\u1eadu + Vi\u00eam \u0111\u1ea1i tr\u00e0ng c\u1ea5p do amip: th\u01b0\u1eddng \u0111au \u1edf h\u1ed1 ch\u1eadu ph\u1ea3i v\u00e0 tr\u00e1i (v\u00f9ng h\u1ed3i manh tr\u00e0ng v\u00e0 \u0111\u1ea1i tr\u00e0ng sigma). C\u00f3 h\u1ed9i ch\u1ee9ng l\u1ef5 + Vi\u00eam ph\u1ea7n ph\u1ee5: th\u01b0\u1eddng \u0111au \u1edf 2 b\u00ean, y\u1ebfu t\u1ed1 l\u00e0m d\u1ec5 l\u00e0 nhi\u1ec5m tr\u00f9ng ng\u01b0\u1ee3c d\u00f2ng t\u1eeb d\u01b0\u1edbi l\u00ean k\u00e8m theo nhi\u1ec5m tr\u00f9ng ra kh\u00ed h\u01b0 (huy\u1ebft tr\u1eafng) + \u0110au b\u1ee5ng giun. + \u0110au b\u1ee5ng do vi\u00eam ru\u1ed9t c\u1ea5p. + C\u01a1n \u0111au qu\u1eb7n th\u1eadn. + \u0110au b\u1ee5ng do nhi\u1ec5m \u0111\u1ed9c ch\u00ec. + \u0110au b\u1ee5ng do d\u1ecb \u1ee9ng. + \u0110au b\u1ee5ng do thi\u1ebfu canxi. + \u0110au b\u1ee5ng \u1edf b\u1ec7nh nhi\u1ec5m khu\u1ea9n. – \u0110au b\u1ee5ng ngo\u1ea1i khoa: + Vi\u00eam ru\u1ed9t th\u1eeba: Kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t, \u0111au \u00e2m \u1ec9 h\u1ed1 ch\u1eadu ph\u1ea3i k\u00e8m theo n\u00f4n ho\u1eb7c b\u00ed trung \u0111\u1ea1i ti\u1ec7n, h\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng. Kh\u00e1m t\u1ea1i ch\u1ed7: \u1ea5n v\u00e0o \u0111i\u1ec3m ru\u1ed9t th\u1eeba r\u1ea5t \u0111au, c\u00f3 ph\u1ea3n \u1ee9ng th\u00e0nh b\u1ee5ng v\u00f9ng h\u1ed1 ch\u1eadu ph\u1ea3i. Th\u0103m tr\u1ef1c tr\u00e0ng hay \u00e2 m \u0111 \u1ea1 o c\u00f3 \u0111au t\u00fai c\u00f9ng b\u00ean ph\u1ea3i + U nang bu\u1ed3ng tr\u1ee9ng b\u1ecb xo\u1eafn: X\u1ea3y ra \u1edf ph\u1ee5 n\u1eef tr\u1ebb r\u1ed1i lo\u1ea1n kinh nguy\u1ec7t, rong kinh, c\u00f3 kh\u1ed1i u tr\u00f2n di \u0111\u1ed9ng \u1edf h\u1ed1 ch\u1eadu, \u0111au d\u1eef d\u1ed9i k\u00e8m d\u1ea5u hi\u1ec7u b\u1ee5ng ngo\u1ea1i khoa + Thai ngo\u00e0i t\u1eed cung v\u1ee1: C\u00f3 d\u1ea5u hi\u1ec7u mang thai. C\u00f3 ra huy\u1ebft \u00e2 m \u0111 \u1ea1 o nh\u1ea5t l\u00e0 3 th\u00e1ng \u0111\u1ea7u, cho\u00e1ng m\u1ea5t m\u00e1u. Kh\u00e1m c\u00f3 d\u1ea5u hi\u1ec7u b\u1ee5ng ngo\u1ea1i khoa – \u0110au b\u1ee5ng c\u1ea5p n\u1ed9i khoa chuy\u1ec3n ngo\u1ea1i khoa:Th\u1ee7ng ru\u1ed9t do th\u01b0\u01a1ng h\u00e0n.T\u1eafc ru\u1ed9t. 2. \u0110au \u1edf v\u00f9ng th\u01b0\u1ee3ng v\u1ecb v\u00e0 ph\u1ea7n b\u1ee5ng tr\u00ean – \u0110au b\u1ee5ng c\u1ea5p n\u1ed9i khoa: + Vi\u00eam d\u1ea1 d\u00e0y c\u1ea5p: C\u01a1n \u0111au x\u1ea3y ra 1 c\u00e1ch r\u1ea5t \u0111\u1ed9t ng\u1ed9t, c\u00f3 th\u1ec3 c\u00f3 y\u1ebfu t\u1ed1 l\u00e0m d\u1ec5 nh\u01b0u th\u1ee9c \u0103n. \u0110au \u1edf v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, lan l\u00ean ng\u1ef1c hay sau x\u01b0\u01a1ng \u1ee9c. N\u00f4n m\u1eeda nhi\u1ec1u, \u0103n v\u00e0o \u0111au th\u00eam, \u0111au ki\u1ec3u n\u00f3ng r\u00e1t. Kh\u00e1m t\u1ea1i ch\u1ed7 c\u00f3 \u1ea5n \u0111au v\u00f9ng th\u01b0\u1ee3ng v\u1ecb + Vi\u00eam t\u1ee5y c\u1ea5p: B\u1ec7nh kh\u1ecfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t. Y\u1ebfu t\u1ed1 l\u00e0m d\u1ec5 l\u00e0 sau 1 b\u1eefa \u0103n th\u1ecbnh so\u1ea1n. \u0110au v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, lan ra sau l\u01b0ng. T\u00ednh ch\u1ea5t \u0111au d\u1eef d\u1ed9i, l\u00e0m b\u1ec7nh nh\u00e2n ph\u1ea3i l\u0103n l\u1ed9n, v\u1eadt v\u00e3, n\u00f4n m\u1eeda nhi\u1ec1u, c\u00f3 th\u1ec3 k\u00e8m theo cho\u00e1ng. C\u00f3 h\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng. Kh\u00e1m b\u1ee5ng c\u00f3 \u0111i\u1ec3m \u0111au t\u1ee5y (+). x\u00e9t nghi\u1ec7m Amylase m\u00e1u t\u0103ng cao. + Giun chui \u1ed1ng m\u1eadt: X\u1ea3y ra r\u1ea5t \u0111\u1ed9t ng\u1ed9t \u1edf ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i, nh\u1ea5t l\u00e0 tr\u1ebb em c\u00f3 ti\u1ec1n s\u1eed nhi\u1ec5m giun. \u0110au v\u00f9ng th\u01b0\u1ee3ng v\u1ecb hay h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, \u0111au d\u1eef d\u1ed9i l\u00e0m BN ph\u1ea3i l\u0103n l\u1ed9n, v\u1eadt v\u00e3. T\u01b0 th\u1ebf gi\u1ea3m \u0111au: t\u01b0 th\u1ebf g\u1ed1i ng\u1ef1c. N\u00f4n m\u1eeda nhi\u1ec1u, c\u00f3 th\u1ec3 n\u00f4n ra giun. Kh\u00e1m: \u1ea5n \u0111i\u1ec3m c\u1ea1nh \u1ee9c ph\u1ea3i hay \u0111i\u1ec3m t\u00fai m\u1eadt \u0111au + Vi\u00eam hay lo\u00e9t d\u1ea1 d\u00e0y hay h\u00e0nh t\u00e1 tr\u00e0ng: \u0110au nhi\u1ec1u \u1edf v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, c\u00f3 th\u1ec3 k\u00e8m theo n\u00f4n hay \u1ee3 chua, \u1ee3 h\u01a1i. Trong ti\u1ec1n s\u1eed th\u01b0\u1eddng c\u00f3 nh\u1eefng c\u01a1n \u0111au theo chu k\u1ef3, xu\u1ea5t hu\u1ec7n v\u00e0o nh\u1eefng gi\u1edd nh\u1ea5t \u0111\u1ecbnh, li\u00ean quan \u0111\u1ebfn c\u00e1c b\u1eefa \u0103n trong ng\u00e0y v\u00e0 v\u00e0o nhwunxg m\u00f9a nh\u1ea5t \u0111\u1ecbnh trong n\u0103m – \u0110au b\u1ee5ng ngo\u1ea1i khoa: + Th\u1ee7ng d\u1ea1 d\u00e0y: Th\u01b0\u1eddng c\u00f3 ti\u1ec1n s\u1eedl o\u00e9t, \u0111ang n\u1eb1m trong c\u01a1n \u0111au lo\u00e9t, c\u01a1n \u0111au \u0111\u1ed9t ng\u1ed9t d\u1eef d\u1ed9i nh\u01b0 dao \u0111\u00e2m. Kh\u00e1m b\u1ee5ng c\u00f3 d\u1ea5u hi\u1ec7u b\u1ee5ng ngo\u1ea1i khoa. G\u00f5 v\u00f9ng \u0111\u1ee5c tr\u01b0\u1edbc gan m\u1ea5t. Th\u00e0nh b\u1ee5ng c\u1ee9ng nh\u01b0 g\u1ed7. Soi ho\u1eb7c ch\u1ee5p c\u01a1 ho\u00e0nh c\u00f3 li\u1ec1m h\u01a1i + Vi\u00eam tu\u1ef5 c\u1ea5p th\u1ec3 ho\u1ea1i t\u1eed: c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p k\u00e8m theo t\u00ecnh tr\u1ea1ng cho\u00e1ng v\u00e0 m\u1ea5t m\u00e1u. Kh\u00e1m t\u1ea1i ch\u1ed7 c\u00f3 bi\u1ec3u hi\u1ec7n b\u1ee5ng ngo\u1ea1i khoa + \u00c1p xe gan: \u0111au v\u00f9ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i lan l\u00ean vai ph\u1ea3i. \u0110au li\u00ean t\u1ee5c, k\u00e8m theo nhi\u1ec5m tr\u00f9ng. Gan l\u1edbn, m\u1ec1m, r\u1ea5t \u0111au. Khi \u00e1p xe ti\u1ebfn tri\u1ec3n v\u1ee1 v\u00e0o \u1ed5 b\u1ee5ng, s\u1ebd g\u00e2y n\u00ean t\u00ecnh tr\u1ea1ng vi\u00eam m\u00e0ng b\u1ee5ng c\u1ea5p – \u0110au b\u1ee5ng c\u1ea5p n\u1ed9i khoa c\u00f3 th\u1ec3 chuy\u1ec3n th\u00e0nht\u00ecnh tr\u1ea1ng ngo\u1ea1i khoa:\u00c1p xe gan.S\u1ecfi m\u1eadt.Vi\u00eam t\u00fai m\u1eadt.Giun chui \u1ed1ng m\u1eadt. C\u00e2u 31: Tr\u00ecnh b\u00e0y th\u0103m kh\u00e1m 1 ng\u01b0\u1eddi b\u1ec7nh gan to? I. Th\u0103m kh\u00e1m to\u00e0n th\u00e2n: – D\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng: Apxe gan …. – V\u00e0ng da, v\u00e0ng m\u1eaft : T\u1eafc m\u1eadt , vi\u00eam gan …. – Thi\u1ebfu m\u00e1u: X\u01a1 gan …. – Suy ki\u1ec7t nhanh : K gan – Ph\u00f9 , kh\u00f3 th\u1edf : Suy tim – C\u00f3 sao m\u1ea1ch kh\u00f4ng, c\u00f3 xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da kh\u00f4ng II. Th\u0103m kh\u00e1m b\u1ee5ng: 1. T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n v\u00e0 th\u1ea7y thu\u1ed1c – BN n\u1eb1m ng\u1eeda ho\u1eb7c nghi\u00eang b\u00ean tr\u00e1i, 2 ch\u00e2n co, \u0111\u1ea7u g\u1ed1i b\u00ecnh th\u01b0\u1eddng – Th\u1ea7y thu\u1ed1c: + Kh\u00e1m th\u00f4ng th\u01b0\u1eddng: \u0110\u1ee9ng ho\u1eb7c ng\u1ed3i b\u00ean ph\u1ea3i Bn + Kh\u00e1m m\u00f3c gan: BN n\u1eb1m nghi\u00ean b\u00ean tr\u00e1i, th\u1ea7y thu\u1ed1c \u0111\u1ee9ng ph\u00eda sau l\u01b0ng BN 2. Thao t\u00e1c k\u1ef9 thu\u1eadt a. Nh\u00ecn: B\u1ee5ng BN \u1edf t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda v\u00e0 t\u01b0 th\u1ebf \u0111\u1ee9ng ph\u00e1t hi\u1ec7n 1 s\u1ed1 tri\u1ec7u ch\u1ee9ng : – C\u1ed5 tr\u01b0\u1edbng: t\u01b0 th\u1ebf \u0111\u1ee9ng x\u1ec7 xu\u1ed1ng, r\u1ed1n l\u1ed3i. t\u01b0 th\u1ebf n\u1eb1m b\u1ee5ng b\u00e8 sang hai b\u00ean, r\u1ed1n n\u1ed3i ho\u1eb7c ph\u1eb3ng – Tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 c\u1eeda – ch\u1ee7 – V\u00f9ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i cao: n\u1ebfu gan to nhi\u1ec1u c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y 1 v\u00f2m n\u1ed5i l\u00ean d\u01b0\u1edbi b\u1edd s\u01b0\u1eddn ph\u1ea3i. – T\u00fai m\u1eadt to:v\u1ecb tr\u00ed t\u00fai m\u1eadt nh\u00ecn th\u1ea5y kh\u1ed1i tr\u00f2n g\u1ed3 cao di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf gi\u1ed1ng nh\u01b0 b\u00f3ng \u0111\u00e8n \u0111\u00e1y tr\u00f2n b. S\u1edd: B\u1ea3o BN th\u1edf ch\u1eadm, s\u00e2u, \u0111\u1ed3ng th\u1eddi th\u1ea3 l\u1ecfng c\u01a1 b\u1ee5ng Tr\u01b0\u1eddng h\u1ee3p gan to v\u1eeba: Th\u1ea7y thu\u1ed1c ng\u1ed3i b\u00ean ph\u1ea3i Bn, \u0111\u1eb7t l\u00f2ng b\u00e0n tay ph\u1ea3i v\u00e0o v\u00f9ng b\u1ee5ng BN d\u01b0\u1edbi h\u1ea1 s\u01b0\u1eddn ph\u1ea3i \u1edf gi\u1eefa \u0111\u01b0\u1eddng n\u00e1ch tr\u01b0\u1edbc v\u00e0 trung \u0111\u00f2n ph\u1ea3i. B\u1ea3o BN h\u00edt s\u00e2u, b\u1edd d\u01b0\u1edbi c\u1ee7a gan h\u1ea1 th\u1ea5p, tr\u01b0\u1ee3t l\u00ean \u0111\u1ea7u ng\u00f3n tay gi\u00fap ta x\u00e1c \u0111\u1ecbnh b\u1edd d\u01b0\u1edbi c\u1ee7a gan. Khi BN th\u1edf ra, th\u1edf v\u00e0o, tay th\u1ea7y thu\u1ed1c s\u1ebd c\u00f3 c\u1ea3m gi\u00e1c gi\u00fap nh\u1eadn \u0111\u1ecbnh v\u1ec1 b\u1edd gan s\u1eafc hay t\u00f9, b\u1ec1 m\u1eb7t gan nh\u1eb5n hay g\u1ed3 gh\u1ec1? M\u1eadt \u0111\u1ed9 c\u1ee7a gan c\u1ee9ng, m\u1ec1m hay ch\u1eafc? \u1ea4n v\u00f9ng gan xem gan c\u00f3 \u0111au kh\u00f4ng? Gan to to\u00e0n th\u1ec3 hay to khu tr\u00fa. – B\u1ec7nh l\u00fd: Gan to v\u1edbi c\u00e1c t\u00ednh ch\u1ea5t: + Gan m\u1ec1m nh\u1eb5n g\u1eb7p trong gan \u1ee9 m\u00e1u do suy tim, vi\u00eam gan + Gan ch\u1eafc b\u1edd s\u1eafc: g\u1eb7p trong vi\u00eam gan m\u1ea1n, x\u01a1 gan + Gan c\u1ee9ng ch\u1eafc l\u1ed5n nh\u1ed5n: k gan, gan \u0111a nang – T\u00fai m\u1eadt: x\u00e1c \u0111\u1ecbnh:\u0110au? M\u1eadt \u0111\u1ed9 c\u0103ng, m\u1ec1m , c\u1ee9ng * C\u00e1c nghi\u1ec7m ph\u00e1p \u0111\u1eb7c bi\u1ec7t khi th\u0103m kh\u00e1m gan. + Nghi\u1ec7m ph\u00e1p ph\u1ea3n h\u1ed3i gan t\u0129nh m\u1ea1ch c\u1eeda: B\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda, \u0111\u1ea7u cao 30 \u0111\u1ed9 so v\u1edbi m\u1eb7t gi\u01b0\u1eddng, 2 ch\u00e2n co ph\u00f9 h\u1ee3p , \u0111\u1ea7u xoay tr\u00e1i b\u1ed9c l\u1ed9 r\u00f5 v\u00f9ng c\u1ed5 ph\u1ea3i. X\u00e1c \u0111\u1ecbnh b\u1edd d\u01b0\u1edbi gan, \u00e1p tay l\u00ean HSF t\u01b0\u01a1ng \u1ee9ng v\u1edbi di\u1ec7n gan. B\u1ea3o b\u1ec7nh nh\u00e2n h\u00edt th\u1eadt s\u00e2u, \u0111\u1ed3ng th\u1eddi \u0111\u1eb7t \u1ea5n s\u00e2u b\u00e0n tay xu\u1ed1ng , Gi\u1eef trong kho\u1ea3ng 10s quan s\u00e1t t\u0129nh m\u1ea1ch c\u1ed5 . N\u1ebfu t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i: nghi\u1ec7m ph\u00e1p (+) \u00e0 gan to do suy tim ph\u1ea3i ho\u1eb7c suy tim to\u00e0n b\u1ed9 N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i s\u1eb5n th\u00ec kh\u00f4ng l\u00e0m nghi\u1ec7m ph\u00e1p n\u00e0y n\u1eefa. + Nghi\u1ec7m ph\u00e1p rung gan: Ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m ng\u1eeda, b\u00e0n tay tr\u00e1i th\u1ea7y thu\u1ed1c \u0111\u1eb7t l\u00ean tr\u00ean v\u00f9ng gan, tay ph\u1ea3i ch\u1eb7t nh\u1eb9 v\u00e0o tay tr\u00e1i, nghi\u1ec7m ph\u00e1p d\u01b0\u01a1ng t\u00ednh khi ng\u01b0\u1eddi b\u1ec7nh \u0111au, c\u00f3 khi r\u1ea5t \u0111au, th\u01b0\u1eddng g\u1eb7p trong b\u1ec7nh \u00e1pxe gan. + Nghi\u1ec7m ph\u00e1p \u1ea5n k\u1ebd s\u01b0\u1eddn: Th\u1ea7y thu\u1ed1c d\u00f9ng ng\u00f3n tay \u1ea5n v\u00e0o c\u00e1c k\u1ebd s\u01b0\u1eddn v\u00f9ng tr\u01b0\u1edbc gan. N\u1ebfu \u0111au l\u00e0 nghi\u1ec7m ph\u00e1p d\u01b0\u01a1ng t\u00ednh, th\u01b0\u1eddng g\u1eb7p trong \u00e1p xe gan. c. G\u00f5 : + X\u00e1c \u0111\u1ecbnh b\u1edd tr\u00ean gan b\u00ecnh th\u01b0\u1eddng: l\u00e0 ranh gi\u1edbi gi\u1eefa ti\u1ebfng trong c\u1ee7a ph\u1ed5i v\u00e0 ti\u1ebfng \u0111\u1ee5c c\u1ee7a gan. \u0110\u1eb7t ng\u00f3n tay gi\u1eefa b\u00e0n tay tr\u00e1i c\u1ee7a th\u1ea7y thu\u1ed1c d\u1ecdc theo c\u00e1c khoang li\u00ean s\u01b0\u1eddn, ng\u00f3n tr\u1ecf tay ph\u1ea3i c\u1ee7a th\u1ea7y thu\u1ed1c g\u00f5 v\u00e0 ng\u00f3n tr\u1ecf tay tr\u00e1i, \u0111\u1ec3 t\u00ecm ranh gi\u1edbi \u00e2m trong v\u00e0 \u0111\u1ee5c. \u1ede ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng, b\u1edd tr\u00ean gan \u1edf: Theo \u0111\u01b0\u1eddng c\u1ea1nh \u1ee9c ph\u1ea3i: li\u00ean s\u01b0\u1eddn 5 Theo \u0111\u01b0\u1eddng gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n: li\u00ean s\u01b0\u1eddn 6 Theo \u0111\u01b0\u1eddng n\u00e1ch tr\u01b0\u1edbc: li\u00ean s\u01b0\u1eddn 7 + X\u00e1c \u0111\u1ecbnh b\u1edd d\u01b0\u1edbi gan b\u00ecnh th\u01b0\u1eddng: B\u1edd d\u01b0\u1edbi c\u1ee7a gan kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 b\u1edd s\u01b0\u1eddn, \u1edf d\u01b0\u1edbi m\u0169i \u1ee9c c\u1ea1nh \u0111\u01b0\u1eddng \u1ee9c ph\u1ea3i 2 cm , kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 \u0111\u01b0\u1eddng c\u1ea1nh \u1ee9c tr\u00e1i . *Ch\u1ea9n \u0111o\u00e1n gan to: Khi chi\u1ec1u cao gan > 12cm<\/p>\n

– B\u1edd tr\u00ean v\u01b0\u1ee3t qu\u00e1 3-4 cm, b\u1edd d\u01b0\u1edbi v\u01b0\u1ee3t qu\u00e1 b\u1edd s\u01b0\u1eddn ph\u1ea3i.<\/p>\n

– T\u00ednh ch\u1ea5t gan to:<\/p>\n

+ Li\u00ean t\u1ee5c v\u1edbi b\u1edd s\u01b0\u1eddn (P) ko c\u00f3 kho\u1ea3ng c\u00e1ch.<\/p>\n

+ Di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf.<\/p>\n

+ Gan l\u00e0 t\u1ea1ng \u0111\u1eb7c n\u00ean khi kh\u00e1m g\u00f5 nghe \u0111\u1ee5c.<\/p>\n

d. Nghe :<\/p>\n

C\u00f3 th\u1ec3 th\u1ea5y ti\u1ebfng th\u1ed5i t\u00e2m thu ho\u1eb7c ti\u1ebfng th\u1ed5i li\u00ean t\u1ee5c do c\u00f3 s\u01b0 t\u0103ng sinh qu\u00e1 m\u1ee9c h\u1ec7 th\u1ed1ng m\u1ea1ch m\u00e1u trong c\u00e1c b\u1ec7nh \u00e1c t\u00ednh c\u1ee7a gan<\/p>\n

III. Th\u0103m kh\u00e1m c\u00e1c c\u01a1 quan c\u00f3 li\u00ean quan:<\/p>\n

+ Li\u00ean quan v\u1ec1 m\u1eb7t c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu:<\/p>\n

Ph\u1ed5i, m\u00e0ng ph\u1ed5i ph\u1ea3i: K ph\u1ed5i , apxe ph\u1ed5i<\/p>\n

T\u00fai m\u1eadt: VD: t\u1eafc m\u1eadt do s\u1ecfi t\u00fai m\u1eadt \u00e0 gan to<\/p>\n

T\u1ee5y t\u1ea1ng: VD: u \u0111\u1ea7u t\u1ee5y \u00e0 ch\u00e8n \u00e9p \u0111\u01b0\u1eddng d\u1eabn m\u1eadt \u00e0 gan to<\/p>\n

+ Li\u00ean quan v\u1ec1 ph\u01b0\u01a1ng di\u1ec7n huy\u1ebft \u0111\u1ed9ng:<\/p>\n

Tim: suy tim ph\u1ea3i ho\u1eb7c suy tim to\u00e0n b\u1ed9 \u00e0 \u1ee9 m\u00e1u ngo\u1ea1i vi \u00e0 gan to<\/p>\n

L\u00e1ch: t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda?<\/p>\n

+ Li\u00ean quan v\u1ec1 ph\u01b0\u01a1ng di\u1ec7n t\u1ed5 ch\u1ee9c h\u1ecdc:<\/p>\n

Gan n\u1eb1m trong nh\u00f3m li\u00ean v\u00f5ng n\u1ed9i m\u00f4 \u00e0 kh\u00e1m h\u1ea1ch, l\u00e1ch, t\u1ee7y x\u01b0\u01a1ng<\/p>\n

IV . H\u1ecfi ti\u1ec1n s\u1eed<\/p>\n

B\u1ea3n th\u00e2n : nghi\u1ec7n r\u01b0\u1ee3u, b\u1ec7nh l\u00fd gan m\u1eadt \u0111\u00e3 m\u1eafc …..<\/p>\n

Gia \u0111\u00ecnh v\u00e0 d\u1ecbch t\u1ec5: c\u00f3 ai m\u1eafc b\u1ec7nh li\u00ean quan ?<\/p>\n

C\u00e2u 32: Tr\u00ecnh b\u00e0y chu\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi gan to?<\/p>\n

-Gan sa: B\u1edd d\u01b0\u1edbi gan xu\u1ed1ng d\u01b0\u1edbi h\u1ea1 s\u01b0\u1eddn ph\u1ea3i 1-2cm, nh\u01b0ng b\u1edd tr\u00ean c\u0169ng xu\u1ed1ng th\u1ea5p \u1edf kho\u1ea3ng gian s\u01b0\u1eddn 6, gian s\u01b0\u1eddn 7 \u0111\u01b0\u1eddng trung \u0111\u00f2n v\u00e0 chi\u1ec1u cao gan \u1edf gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng: kho\u1ea3ng 9-12cm.<\/p>\n

-T\u00fai m\u1eadt to: u tr\u00f2n \u0111\u1ec1u di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf \u1edf g\u00f3c b\u1edd s\u01b0\u1eddn, m\u1eadt \u0111\u1ed9 m\u1ec1m hay ch\u1eafc t\u00f9y v\u00e0o b\u1ec7nh l\u00fd nguy\u00ean nh\u00e2n. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh c\u1ea7n d\u1ef1a tr\u00ean si\u00eau \u00e2m.<\/p>\n

-Th\u1eadn ph\u1ea3i to: Ranh gi\u1edbi kh\u00f4ng r\u00f5, c\u00f3 d\u1ea5u hi\u1ec7u ch\u1ea1m th\u1eaft l\u01b0ng, g\u00f5 d\u01b0\u1edbi h\u1ea1 s\u01b0\u1eddn ph\u1ea3i nghe trong<\/p>\n

-Kh\u1ed1i u d\u1ea1 d\u00e0y: d\u1ec5 nh\u1ea7m v\u1edbi gan to th\u00f9y tr\u00e1i, kh\u00f4ng di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf, g\u00f5 trong, c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh l\u00ed d\u1ea1 d\u00e0y.<\/p>\n

– Vi\u00eam c\u01a1 th\u00e0nh b\u1ee5ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i: v\u1ecb tr\u00ed kh\u1ed1i u n\u00f4ng, ch\u1ea1y d\u1ecdc theo c\u01a1 th\u1eb3ng b\u1ee5ng, kh\u00f4ng di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf. Khi g\u1ed3ng c\u01a1 b\u1ee5ng u s\u1ebd xu\u1ea5t hi\u1ec7n r\u00f5 h\u01a1n.<\/p>\n

– Kh\u1ed1i u g\u00f3c \u0111\u1ea1i tr\u00e0ng ph\u1ea3i: ch\u1ec9 nh\u1ea7m v\u1edbi gan to khi kh\u1ed1i u d\u00ednh v\u1edbi gan n\u00ean di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf, th\u01b0\u1eddng c\u00f3 d\u1ea5u hi\u1ec7u b\u00e1n t\u1eafc ru\u1ed9t.<\/p>\n

C\u00e2u 33: Tr\u00ecnh b\u00e0y c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y gan to?<\/p>\n

– Suy tim: M\u1ee9c \u0111\u1ed9 gan to to\u00e0n th\u1ec3, m\u1ee9c \u0111\u1ed9 to t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 suy tim, m\u1eadt \u0111\u1ed9m\u1ec1m, m\u1eb7t nh\u1eb5n, \u1ea5n gan c\u00f3 c\u1ea3m gi\u00e1c t\u1ee9c ho\u1eb7c \u0111au nh\u1eb9, gan \u0111\u00e0n x\u1ebfp: gan nh\u1ecf l\u1ea1i khi \u0111i\u1ec1u tr\u1ecb l\u00e0nh suy tim v\u00e0 gan to d\u1ea7n tr\u1edf l\u1ea1i khi b\u1ec7nh nh\u00e2n b\u1ecb suy tim t\u00e1i ph\u00e1t, n\u1ebfu suy tim giai \u0111\u1ecdan cu\u1ed1i: suy tim \u0111\u1ed9 4 r\u1ea5t kh\u00f3 \u0111i\u1ec1u tr\u1ecb, gan to l\u00e2u ng\u00e0y tr\u1edf n\u00ean x\u01a1 c\u1ee9ng g\u1ecdi l\u00e0 x\u01a1 gan tim.<\/p>\n

– \u00c1p xe gan: gan to nhanh, to khu tr\u00fa, k\u00e8m h\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng, rung gan d\u01b0\u01a1ng t\u00ednh, \u1ea5n k\u1ebd s\u01b0\u1eddn c\u00f3 v\u1ecb tr\u00ed \u0111au ch\u00f3i t\u01b0\u01a1ng \u1ee9ng v\u1edbi v\u1ecb tr\u00ed \u00e1p xe gan, b\u1edd t\u00f9.<\/p>\n

– Nang gan: gan to nhi\u1ec1u hay \u00edt t\u00f9y theo k\u00edch th\u01b0\u1edbc c\u1ee7a nang, c\u00f3 th\u1ec3 l\u00e0 s\u00e1n l\u00e1 gan, th\u01b0\u1eddng \u0111au \u00edt ho\u1eb7c kh\u00f4ng \u0111au, kh\u00f4ng c\u00f3 h\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng.<\/p>\n

– Gan to do t\u1eafc m\u1eadt: th\u01b0\u1eddng g\u1eb7p trong s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7, s\u1ecfi \u1ed1ng gan ho\u1eb7c u \u0111\u1ea7u t\u1ee5y, k\u00e8m theo tri\u1ec7u ch\u1ee9ng v\u00e0ng da t\u1eafc m\u1eadt, gan to m\u1ed9t th\u00f9y hay to to\u00e0n th\u1ec3 t\u00f9y v\u1ecb tr\u00ed t\u1eafc m\u1eadt, \u0111au v\u1eeba.<\/p>\n

– K gan: gan to khu tr\u00fa m\u1ed9t th\u00f9y, b\u1edd t\u00f9, m\u1eadt \u0111\u1ed9 ch\u1eafc ho\u1eb7c c\u1ee9ng, giai \u0111\u1ecdan mu\u1ed9n c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111au, k\u00e8m d\u1ea5u hi\u1ec7u suy gan v\u00e0 c\u01a1 th\u1ec3 suy ki\u1ec7t.<\/p>\n

– Vi\u00eam gan c\u1ea5p ho\u1eb7c vi\u00eam gan m\u00e3n: gan th\u01b0\u1eddng ch\u1ec9 h\u01a1i l\u1edbn, d\u01b0\u1edbi b\u1edd s\u01b0\u1eddn kho\u1ea3ng 1- 2cm, \u1ea5n t\u1ee9c nh\u1eb9, c\u00f3 c\u1ea3m gi\u00e1c t\u1ee9c nh\u1eb9 v\u00f9ng gan. K\u00e8m c\u00e1c tri\u1ec7u ch\u1ee9ng nhi\u1ec5m si\u00eau vi gan c\u1ea5p ho\u1eb7c m\u1ea1n.<\/p>\n

C\u00e2u 34: Th\u0103m kh\u00e1m v\u00e0 ch\u1ea9n \u0111o\u00e1n c\u1ed5 ch\u01b0\u1edbng?<\/p>\n

*L\u00e2m s\u00e0ng :<\/p>\n

– C\u01a1 n\u0103ng: Tr\u01b0\u1edbc khi xu\u1ea5t hi\u1ec7n d\u1ecbch, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng th\u1ea5y m\u1ec7t m\u1ecfi, ch\u00e1n \u0103n, ng\u01b0\u1eddi g\u1ea7y s\u00fat, \u0111\u1ea7y b\u1ee5ng. Tu\u1ef3 theo nguy\u00ean nh\u00e2n m\u00e0 c\u00f3 th\u1ec3 s\u1ed1t nh\u1eb9 hay \u0111au \u00e2m \u1ec9 v\u00f9ng b\u1ee5ng<\/p>\n

-Th\u1ef1c th\u1ec3:<\/p>\n

+\u0110\u1ed1i v\u1edbi c\u1ed5 ch\u01b0\u1edbng th\u1ec3 t\u1ef1 do lo\u1ea1i nhi\u1ec1u n\u01b0\u1edbc v\u00e0 trung b\u00ecnh<\/p>\n

Nh\u00ecn: Da b\u1ee5ng c\u0103ng b\u00f3ng, r\u1ed1n l\u1ed3i. Tu\u1ef3 theo nguy\u00ean nh\u00e2n m\u00e0 c\u00f3 th\u1ec3 th\u1ea5y tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 c\u1eeda – ch\u1ee7. Khi b\u1ec7nh nh\u00e2n n\u1eb1m b\u1ee5ng b\u00e8 ra 2 b\u00ean, b\u1ee5ng s\u1ec7 ra ph\u00eda tr\u01b0\u1edbc v\u00e0 xu\u1ed1ng d\u01b0\u1edbi khi \u0111\u1ee9ng hay ng\u1ed3i<\/p>\n

S\u1edd: S\u1edd c\u00f3 c\u1ea3m gi\u00e1c c\u0103ng v\u00e0 c\u00f3 d\u1ea5u hi\u1ec7u s\u00f3ng v\u1ed7 n\u1ebfu l\u00e0 c\u1ed5 ch\u01b0\u1edbng t\u1ef1 do, n\u1ebfu c\u00f3 gan l\u00e1ch to th\u00ec s\u1ebd c\u00f3 d\u1ea5u hi\u1ec7u ch\u1ea1m c\u1ee5c \u0111\u00e1<\/p>\n

G\u00f5: \u0110\u1ed1i v\u1edbi c\u1ed5 ch\u01b0\u1edbng t\u1ef1 do s\u1ebd th\u1ea5y g\u00f5 \u0111\u1ee5c v\u00f9ng th\u1ea5p v\u00e0 hai b\u00ean gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a v\u00f9ng \u0111\u1ee5c l\u00e0 1 \u0111\u01b0\u1eddng cong l\u00f5m. Thay \u0111\u1ed5i t\u01b0 th\u1ebf v\u00f9ng \u0111\u1ee5c, v\u00f9ng trong s\u1ebd thay \u0111\u1ed5i theo<\/p>\n

+Trong tr\u01b0\u1eddng h\u1ee3p d\u1ecbch \u00edt:c\u00f3 th\u1ec3 thay \u0111\u1ed5i t\u01b0 th\u1ebf BN hay th\u0103m tr\u1ef1c tr\u00e0ng ho\u1eb7c \u00e2 m \u0111 \u1ea1 o th\u1ea5y c\u00f3 t\u00fai c\u00f9ng c\u0103ng, \u1ea5n tay tr\u00ean b\u1ee5ng s\u1ebd c\u00f3 n\u01b0\u1edbc ch\u1ea1m v\u00e0o \u0111\u1ea7u c\u00e1c ng\u00f3n tay, ch\u1ecdc d\u00f2 c\u1ed5 ch\u01b0\u1edbng h\u00fat ra n\u01b0\u1edbc<\/p>\n

+ \u0110\u1ed1i v\u1edbi c\u1ed5 ch\u01b0\u1edbng th\u1ec3 khu tr\u00fa: G\u00f5 s\u1ebd c\u00f3 ch\u1ed7 \u0111\u1ee5c ch\u1ed7 trong xen k\u1ebd. Ch\u1ecdc d\u00f2 nh\u1eefng v\u00f9ng nghi c\u00f3 n\u01b0\u1edbc s\u1ebd h\u00fat ra n\u01b0\u1edbc<\/p>\n

* C\u1eadn l\u00e2m s\u00e0ng:<\/p>\n

– Ch\u1ecdc d\u00f2 d\u1ecbch c\u1ed5 ch\u01b0\u1edbng; d\u1ecbch c\u00f3 th\u1ec3 trong, v\u00e0ng chanh, v\u00e0ng r\u01a1m, c\u00f3 m\u00e1u hay \u0111\u1ee5c nh\u01b0 s\u1eefa<\/p>\n

C\u00f3 2 lo\u1ea1i d\u1ecbch<\/p>\n

D\u1ecbch th\u1ea5m: N\u01b0\u1edbc trongv\u00e0ng chanh, v\u00e0ng r\u01a1m<\/p>\n

1. L\u01b0\u1ee3ng Protein < 30g\/ l 2. Ph\u1ea3n \u1ee9ng Rivalta \u00e2m t\u00ednh 3. \u00cdt t\u1ebf b\u00e0o D\u1ecbch ti\u1ebft: V\u00e0ng s\u1eabm, \u0111\u1ecf m\u00e1u, \u0111\u1ee5c hay \u0111\u1ee5c nh\u01b0 s\u1eefa 1. L\u01b0\u1ee3ng Protein > 30g\/ l<\/p>\n

2. Ph\u1ea3n \u1ee9ng Rivalta d\u01b0\u01a1ng t\u00ednh<\/p>\n

3. Nhi\u1ec1u t\u1ebf b\u00e0o<\/p>\n

4. Ngo\u00e0i ra c\u00f2n c\u00f3 d\u1ecbch to\u00e0n m\u00e1u kh\u00f4ng \u0111\u00f4ng nhi\u1ec1u h\u1ed3ng c\u1ea7u v\u00e0 b\u1ea1ch c\u1ea7u, v\u00e0 c\u00f3 th\u1ec3 c\u00f3 t\u1ebf b\u00e0o l\u1ea1 g\u1eb7p trong ung th\u01b0<\/p>\n

5. Th\u0103m d\u00f2 h\u00ecnh \u1ea3nh:<\/p>\n

6. Si\u00eau \u00e2m: gi\u00fap ch\u1ea9n \u0111o\u00e1n s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a b\u00e1ng. H\u01b0\u1edbng d\u1eabn ch\u1ecdc h\u00fat b\u00e1ng trong tr\u01b0\u1eddng h\u1ee3p s\u1ed1 l\u01b0\u1ee3ng \u00edt. Cung c\u1ea5p c\u00e1c th\u00f4ng tin v\u1ec1 b\u1ec7nh nguy\u00ean nh\u00e2n nh\u01b0 h\u1ed9i ch\u1ee9ng t\u0103ng \u00e1p c\u1eeda, th\u01b0\u01a1ng t\u1ed5n gan, h\u1ea1ch, t\u1ee5y, m\u1ea1c treo, bu\u1ed3ng tr\u1ee9ng.<\/p>\n

7. Soi \u1ed5 b\u1ee5ng: cho ph\u00e9p quan s\u00e1t tr\u1ef1c ti\u1ebfp v\u00e0 sinh thi\u1ebft ph\u00fac m\u1ea1c, gan v\u00e0 m\u1ed9t s\u1ed1 h\u1ea1ch \u1ed5 b\u1ee5ng<\/p>\n

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

– Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh: D\u1ec5, tr\u1eeb tr\u01b0\u1eddng h\u1ee3p d\u1ecbch \u00edt ph\u1ea3i g\u00f5 nhi\u1ec1u t\u01b0 th\u1ebf, ch\u1eafc ch\u1eafn nh\u1ea5t l\u00e0 ch\u1ecdc d\u00f2 c\u00f3 d\u1ecbch<\/p>\n

– Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/p>\n

+B\u1ee5ng b\u00e9o nhi\u1ec1u m\u1ee1: B\u1ee5ng ch\u1eafc, da b\u1ee5ng d\u00e0y, r\u1ed1n l\u1ed3i, g\u00f5 trong v\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u s\u00f3ng v\u1ed7<\/p>\n

+ B\u1ee5ng ch\u01b0\u1edbng h\u01a1i: G\u00f5 trong to\u00e0n b\u1ee5ng<\/p>\n

+ B\u00e0ng quang c\u0103ng trong b\u00ed ti\u1ec3u: B\u1ec7nh nh\u00e2n c\u00f3 c\u1ea3m gi\u00e1c t\u1ee9c ti\u1ec3u nh\u01b0ng kh\u00f4ng ti\u1ec3u \u0111\u01b0\u1ee3c, g\u00f5 v\u00f9ng \u0111\u1ee5c h\u1ea1 v\u1ecb, gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a v\u00f9ng \u0111\u1ee5c l\u00e0 1 \u0111\u01b0\u1eddng cong l\u1ed3i l\u00ean tr\u00ean, x\u00f4ng ti\u1ec3u s\u1ebd h\u1ebft<\/p>\n

+ U nang, nh\u1ea5t l\u00e0 u nang n\u01b0\u1edbc c\u1ee7a bu\u1ed3ng tr\u1ee9ng: G\u00f5th\u1ea5y v\u00f9ng \u0111\u1ee5c \u1edf gi\u1eefa, xung quanh trong, gi\u1edbi h\u1ea1n gi\u1eefa v\u00f9ng \u0111\u1ee5c v\u00e0 v\u00f9ng trong l\u00e0 1 \u0111\u01b0\u1eddng cong l\u1ed3i l\u00ean tr\u00ean. Tr\u01b0\u1eddng h\u1ee3p kh\u00f3 ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 nh\u1edd si\u00eau \u00e2m x\u00e1c \u0111\u1ecbnh<\/p>\n

C\u00e2u 35: C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y c\u1ed5 ch\u01b0\u1edbng?<\/p>\n

* C\u1ed5 ch\u01b0\u1edbng d\u1ecbch th\u1ea5m<\/p>\n

-X\u01a1 gan: Trong x\u01a1 gan ch\u00fang ta g\u1eb7p c\u1ed5 ch\u01b0\u1edbng t\u1ef1 do, tr\u00ean da b\u1ee5ng c\u00f3 tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7, k\u00e8m d\u1ea5u hi\u1ec7u suy ch\u1ee9c n\u0103ng gan nh\u01b0 k\u00e9m \u0103n, s\u1ee3 m\u1ee1, v\u00e0ng da, n\u1ed1t nh\u1ec7n \u0111\u1ecf.<\/p>\n

-Suy tim: G\u1eb7p trong c\u00e1c b\u1ec7nh suy tim to\u00e0n b\u1ed9, suy tim ph\u1ea3i hay h\u1ed9i ch\u1ee9ng Pick (vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft). D\u1ecbch m\u00e0u v\u00e0ng chanh hay v\u00e0ng r\u01a1m<\/p>\n

– B\u1ec7nh th\u1eadn: Th\u01b0\u1eddng g\u1eb7p trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, vi\u00eam c\u1ea7u th\u1eadn b\u00e1n c\u1ea5p. . . Ngo\u00e0i c\u1ed5 ch\u01b0\u1edbng c\u00f2n c\u00f3 d\u1ea5u hi\u1ec7u ph\u00f9 to\u00e0n th\u00e2n, tri\u1ec7u ch\u1ee9ng kh\u00e1c v\u1ec1 b\u1ec7nh th\u1eadn. D\u1ecbch th\u01b0\u1eddng trong<\/p>\n

– Suy dinh d\u01b0\u1ee1ng: B\u1ec7nh nh\u00e2n ph\u00f9 to\u00e0n th\u00e2n v\u00e0 c\u00f3 c\u1ed5 ch\u01b0\u1edbng. D\u1ecbch r\u1ea5t trong v\u00e0 l\u01b0\u1ee3ng Protein r\u1ea5t th\u1ea5p, Protein m\u00e1u gi\u1ea3m<\/p>\n

* D\u1ecbch ti\u1ebft:<\/p>\n

-K gan: C\u1ed5 ch\u01b0\u1edbng t\u1ef1 do, ph\u00e1t tri\u1ec3n r\u1ea5t nhanh, d\u1ecbch th\u01b0\u1eddng c\u00f3 m\u00e1u, c\u00f3 th\u1ec3 c\u00f3 t\u1ebf b\u00e0o l\u1ea1 k\u00e8m theo gan to c\u1ee9ng v\u00e0 suy s\u1ee5p to\u00e0n th\u00e2n<\/p>\n

– Lao m\u00e0ng b\u1ee5ng: C\u00f3 2 lo\u1ea1i c\u1ed5 ch\u01b0\u1edbng<\/p>\n

+C\u1ed5 ch\u01b0\u1edbng t\u1ef1 do: D\u1ecbch th\u01b0\u1eddng \u00edt hay trung b\u00ecnh k\u00e8m theo \u1ea5n \u0111au kh\u1eafp b\u1ee5ng IDR d\u01b0\u01a1ng t\u00ednh k\u00e8m theo c\u00f3 d\u1ea5u nhi\u1ec5m lao \u1edf c\u00e1c b\u1ed9 ph\u1eadn kh\u00e1c nh\u01b0 lao ph\u1ed5i<\/p>\n

+C\u1ed5 ch\u01b0\u1edbng khu tr\u00fa: B\u1ec7nh nh\u00e2n \u0111au m\u01a1 h\u1ed3 kh\u1eafp \u1ed5 b\u1ee5ng, m\u00e0ng b\u1ee5ng b\u1ecb vi\u00eam d\u00ednh, n\u01b0\u1edbc xu\u1ea5t hi\u1ec7n t\u1eebng v\u00f9ng, \u1ea5n ch\u1ed7 m\u1ec1m ch\u1ed7 r\u1eafn, g\u00f5 ch\u1ed7 \u0111\u1ee5c ch\u1ed7 trong Ngo\u00e0i ra c\u00f3 d\u1ea5u hi\u1ec7u b\u00e1n t\u1eafc ru\u1ed9t v\u00e0 d\u1ea5u nhi\u1ec5m lao.<\/p>\n

D\u1ecbch c\u1ed5 ch\u01b0\u1edbng trong lao m\u00e0ng b\u1ee5ng c\u00f3 c\u1ea3 2 th\u1ec3 th\u01b0\u1eddng l\u00e0 v\u00e0ng chanh, c\u0169ng c\u00f3 th\u1ec3 c\u00f3 m\u00e1u, x\u00e9t nghi\u1ec7m c\u00f3 nhi\u1ec1u b\u1ea1ch c\u1ea7u Lympho.<\/p>\n

– K c\u00e1c h\u1ea1ch trong \u1ed5 b\u1ee5ng: V\u00ed d\u1ee5 K h\u1ea1ch m\u1ea1c treo hay Lymphosarcoma. D\u1ecbch c\u00f3 m\u00e1u, c\u00f3 khi t\u00ecm th\u1ea5y t\u1ebf b\u00e0o l\u1ea1<\/p>\n

– Vi\u00eam m\u00e0ng b\u1ee5ng: G\u1eb7p trong th\u1ee7ng d\u1ea1 d\u00e0y, vi\u00eam ru\u1ed9t th\u1eeba v\u1ee1 m\u1ee7, abces gan v\u1ee1 Ngo\u00e0i ra c\u00f3 1 s\u1ed1 c\u1ed5 ch\u01b0\u1edbng kh\u00e1c hi\u1ebfm g\u1eb7p tr\u00ean l\u00e2m s\u00e0ng nh\u01b0:<\/p>\n

– C\u1ed5 ch\u01b0\u1edbng d\u01b0\u1ee1ng ch\u1ea5p: D\u1ecbch m\u00e0ng b\u1ee5ng to\u00e0n d\u01b0\u1ee1ng ch\u1ea5p, \u0111\u1ee5c nh\u01b0 s\u1eefa. Th\u01b0\u1eddng g\u1eb7p do giun ch\u1ec9 hay K c\u00e1c n\u01a1i di c\u0103n v\u00e0o m\u1ea1ch b\u1ea1ch huy\u1ebft l\u00e0m v\u1ee1 m\u1ea1ch b\u1ea1ch huy\u1ebft<\/p>\n

C\u00e2u 36: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a v\u00e0 c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y thi\u1ebfu m\u00e1u ?<\/p>\n

I. \u0110\u1ecbnh ngh\u0129a:<\/p>\n

Thi\u1ebfu m\u00e1u l\u00e0 t\u00ecnh tr\u1ea1ng gi\u1ea3m s\u00fat c\u1ee7a l\u01b0\u1ee3ng huy\u1ebft s\u1eafc t\u1ed1 (hemoglobin-Hb) trong m\u1ed9t \u0111\u01a1n v\u1ecb th\u1ec3 t\u00edch m\u00e1u d\u1eabn \u0111\u1ebfn m\u00e1u thi\u1ebfu oxy \u0111\u1ec3 cung c\u1ea5p cho c\u00e1c m\u00f4 t\u1ebf b\u00e0o trong c\u01a1 th\u1ec3.<\/p>\n

Theo t\u1ed5 ch\u1ee9c y t\u1ebf th\u1ebf gi\u1edbi: Thi\u1ebfu m\u00e1u x\u1ea3y ra khi m\u1ee9c \u0111\u1ed9 huy\u1ebft s\u1eafc t\u1ed1 (Hb) l\u01b0u h\u00e0nh c\u1ee7a 1 ng\u01b0\u1eddi n\u00e0o \u0111\u00f3 th\u1ea5p h\u01a1n m\u1ee9c c\u1ee7a ng\u01b0\u1eddi kh\u1ecfe m\u1ea1nh c\u00f9ng gi\u1edbi, c\u00f9ng tu\u1ed5i v\u00e0 c\u0169ng 1 m\u00f4i tr\u01b0\u1eddng s\u1ed1ng<\/p>\n

M\u1ed9t ng\u01b0\u1eddi \u0111\u01b0\u1ee3c coi l\u00e0 thi\u1ebfu m\u00e1u khi m\u1ee9c Hb<12g\/dl v\u1edbi ng\u01b0\u1eddi >10 tu\u1ed5i ho\u1eb7c Hb <11g\/dl \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi < 10 tu\u1ed5i.<\/p>\n

\u00d8 Ch\u00fa \u00fd:<\/p>\n

Hb l\u00e0 ch\u1ec9 s\u1ed1 c\u00f3 gi\u00e1 tr\u1ecb nh\u1ea5t ph\u1ea3n \u00e1nh t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u<\/p>\n

S\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u v\u00e0 hematocrit (Hct) l\u00e0 m\u1ed9t ch\u1ec9 s\u1ed1 ph\u1ea3n \u00e1nh kh\u00f4ng trung th\u00e0nh c\u1ee7a thi\u1ebfu m\u00e1u<\/p>\n

C\u1ea7n ph\u00e2n bi\u1ec7t thi\u1ebfu m\u00e1u v\u1edbi: t\u00ecnh tr\u1ea1ng c\u00f4 \u0111\u1eb7c m\u00e1u, pha lo\u00e3ng m\u00e1u, tr\u1ebb s\u01a1 sinh, ph\u1ee5 n\u1eef c\u00f3 thai<\/p>\n

II. Nguy\u00ean nh\u00e2n thi\u1ebfu m\u00e1u:<\/p>\n

1. Thi\u1ebfu m\u00e1u do gi\u1ea3m sinh:<\/p>\n

\u2013 Do thi\u1ebfu y\u1ebfu t\u1ed1 t\u1ea1o m\u00e1u:<\/p>\n

+ Thi\u1ebfu s\u1eaft.<\/p>\n

+ Thi\u1ebfu acid folic.<\/p>\n

+ Thi\u1ebfu vitamin B12, vitamin B6.<\/p>\n

+ Thi\u1ebfu protein.<\/p>\n

\u2013 Do gi\u1ea3m s\u1ea3n ho\u1eb7c b\u1ea5t s\u1ea3n t\u1ee7y (r\u1ed1i lo\u1ea1n t\u1ea1o h\u1ed3ng c\u1ea7u \u1edf t\u1ee7y x\u01b0\u01a1ng):<\/p>\n

+ Suy t\u1ee7y<\/p>\n

+ Th\u00e2m nhi\u1ec5m t\u1ee7y: t\u1ee7y x\u01b0\u01a1ng b\u1ecb l\u1ea5n \u00e1t, ch\u00e8n \u00e9p do c\u00e1c t\u1ed5 ch\u1ee9c \u00e1c t\u00ednh ho\u1eb7c di c\u0103n ung th\u01b0 v\u00e0o t\u1ee7y x\u01b0\u01a1ng.<\/p>\n

+ B\u1ec7nh kh\u00e1c: Suy th\u1eadn m\u1ea1n, nhi\u1ec5m khu\u1ea9n m\u1ea1n, b\u1ec7nh h\u1ec7 th\u1ed1ng…<\/p>\n

2. Thi\u1ebfu m\u00e1u do tan m\u00e1u:<\/p>\n

\u2013 Tan m\u00e1u c\u1ea5p: nguy\u00ean nh\u00e2n th\u01b0\u1eddng do ngo\u00e0i h\u1ed3ng c\u1ea7u nh\u01b0:<\/p>\n

+ S\u1ed1t r\u00e9t<\/p>\n

+ Ng\u1ed9 \u0111\u1ed9c: thu\u1ed1c (thu\u1ed1c s\u1ed1t r\u00e9t, nitrate…), n\u1ecdc r\u1eafn v\u00e0 c\u00f4n tr\u00f9ng.<\/p>\n

+ Nhi\u1ec5m tr\u00f9ng huy\u1ebft<\/p>\n

+ B\u1ecfng<\/p>\n

+ Truy\u1ec1n nh\u1ea7m nh\u00f3m m\u00e1u (th\u01b0\u1eddng l\u00e0 h\u1ec7 ABO).<\/p>\n

\u2013 Tan m\u00e1u m\u1ea1n: nguy\u00ean nh\u00e2n th\u01b0\u1eddng t\u1ea1i h\u1ed3ng c\u1ea7u nh\u01b0:<\/p>\n

+ B\u1ea5t th\u01b0\u1eddng c\u1ea5u tr\u00fac m\u00e0ng h\u1ed3ng c\u1ea7u (b\u1ec7nh h\u1ed3ng c\u1ea7u h\u00ecnh bi…)<\/p>\n

+ Thi\u1ebfu h\u1ee5t men (G6PD, pyruvat kinase…)<\/p>\n

+ R\u1ed1i lo\u1ea1n huy\u1ebft s\u1eafc t\u1ed1 (thalassemie, b\u1ec7nh h\u1ed3ng c\u1ea7u h\u00ecnh l\u01b0\u1ee1i li\u1ec1m…).<\/p>\n

+ Ngo\u00e0i ra c\u00f2n g\u1eb7p tan m\u00e1u m\u1ea1n do nguy\u00ean nh\u00e2n ngo\u00e0i h\u1ed3ng c\u1ea7u nh\u01b0 do mi\u1ec5n d\u1ecbch, c\u01b0\u1eddng l\u00e1ch.<\/p>\n

3. Thi\u1ebfu m\u00e1u do ch\u1ea3y m\u00e1u:<\/p>\n

\u2013 Ch\u1ea3y m\u00e1u c\u1ea5p:<\/p>\n

+ Ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n

+ Xu\u1ea5t huy\u1ebft n\u1ed9i: th\u01b0\u1eddng g\u1eb7p ch\u1ea3y m\u00e1u d\u1ea1 d\u00e0y- t\u00e1 tr\u00e0ng.<\/p>\n

+ Ch\u1ea3y m\u00e1u cam.<\/p>\n

\u2013 Ch\u1ea3y m\u00e1u m\u1ea1n:<\/p>\n

+ Giun m\u00f3c<\/p>\n

+ Vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng, vi\u00eam lo\u00e9t \u0111\u01b0\u1eddng m\u1eadt, tr\u0129…<\/p>\n

+ R\u1ed1i lo\u1ea1n c\u1ea7m m\u00e1u: gi\u1ea3m ti\u1ec3u c\u1ea7u, hemophilie…<\/p>\n

C\u00e2u 37: Tr\u00ecnh b\u00e0y c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 ph\u00e2n \u0111\u1ed9 thi\u1ebfu m\u00e1u c\u1ea5p ?<\/p>\n

1. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ph\u1ee5 thu\u1ed9c r\u1ea5t nhi\u1ec1u v\u00e0o t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u v\u00e0 kh\u1ea3 n\u0103ng th\u00edch nghi c\u1ee7a c\u01a1 th\u1ec3.<\/p>\n

Thi\u1ebfu m\u00e1u c\u1ea5p:x\u1ea3y ra nhanh ch\u00f3ng sau tan m\u00e1u nhi\u1ec1u ho\u1eb7c xu\u1ea5t huy\u1ebft n\u1eb7ng.<\/p>\n

v C\u01a1 n\u0103ng:<\/p>\n

– Th\u1ea7n khinh: hoa m\u1eaft, ch\u00f3ng m\u1eb7t, \u00f9 tai, c\u00f3 th\u1ec3 ng\u1ea5t, l\u01a1 m\u01a1 ho\u1eb7c h\u00f4n m\u00ea n\u1ebfu m\u1ea5t m\u00e1u nhi\u1ec1u.<\/p>\n

– H\u00f4 h\u1ea5p: kh\u00f3 th\u1edf, nh\u1ecbp th\u1edf nhanh.<\/p>\n

– C\u01a1, kh\u1edbp: m\u1ecfi c\u00e1c c\u01a1, \u0111i l\u1ea1i kh\u00f3 kh\u0103n.<\/p>\n

v Th\u1ef1c th\u1ec3:<\/p>\n

– Da, ni\u00eam m\u1ea1c nh\u1ee3t nh\u1ea1t, l\u00f2ng b\u00e0n tay tr\u1eafng b\u1ec7ch.<\/p>\n

– Tim m\u1ea1ch: nh\u1ecbp tim nhanh, huy\u1ebft \u00e1p c\u00f3 th\u1ec3 t\u1ee5t ho\u1eb7c k\u1eb9t, v\u00e0 c\u00f3 th\u1ec3 c\u00f3 ti\u1ebfng th\u1ed5i t\u00e2m thu thi\u1ebfu m\u00e1u, th\u01b0\u1eddng nghe r\u00f5 \u1edf gi\u1eefa tim, c\u00f3 th\u1ec3 nghe th\u1ea5y \u1edf m\u1ecfm tim, l\u00e0 ti\u1ebfng th\u1ed5i c\u01a1 n\u0103ng do m\u00e1u lo\u00e3ng g\u00e2y ra.<\/p>\n

2. Ph\u00e2n \u0111\u1ed9 thi\u1ebfu m\u00e1u c\u1ea5p:N\u1ebfu thi\u1ebfu m\u00e1u c\u1ea5p do ch\u1ea3y m\u00e1u th\u00ec ph\u00e2n \u0111\u1ed9 d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng, n\u1ebfu d\u1ef1a v\u00e0o c\u1eadn l\u00e2m s\u00e0ng th\u00ec ph\u1ea3i sau 6 gi\u1edd c\u00f4ng th\u1ee9c m\u00e1u m\u1edbi bi\u1ebfn \u0111\u1ed5i.<\/p>\n

D\u1ea5u hi\u1ec7u<\/p>\n

M\u1ee9c \u0111\u1ed9<\/p>\n

Th\u1ea7n kinh<\/p>\n

M\u1ea1ch<\/p>\n

Huy\u1ebft \u00e1p<\/p>\n

Nh\u1eb9<\/p>\n

B\u00ecnh th\u01b0\u1eddng<\/p>\n

<100 l\u1ea7n\/ph\u00fat >90 mmHg<\/p>\n

V\u1eeba<\/p>\n

Hoa m\u1eaft, ch\u00f3ng m\u1eb7t<\/p>\n

100 – 120 l\u1ea7n\/ph\u00fat<\/p>\n

70 – 90 mmHg<\/p>\n

N\u1eb7ng<\/p>\n

K\u00edch th\u00edch, h\u00f4n m\u00ea<\/p>\n

>120 l\u1ea7n\/ph\u00fat<\/p>\n

< 70 mmHg ho\u1eb7c kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c<\/p>\n

C\u00e2u 38:ph\u00e2n bi\u1ec7t thi\u1ebfu m\u00e1u c\u1ea5p v\u00e0 thi\u1ebfu m\u00e1u m\u1ea1n?<\/p>\n

\u2013 Thi\u1ebfu m\u00e1u c\u1ea5p:<\/p>\n

+ X\u1ea3y ra nhanh ho\u1eb7c \u0111\u1ed9t ng\u1ed9t.<\/p>\n

+ C\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn huy\u1ebft \u0111\u1ed9ng (m\u1ea1ch nhanh, huy\u1ebft \u00e1p t\u1ee5t) m\u00e0 ch\u01b0a c\u00f3 \u1ea3nh h\u01b0\u1edfng l\u00e2u d\u00e0i \u0111\u1ebfn c\u00e1c b\u1ed9 ph\u1eadn kh\u00e1c (ti\u00eau h\u00f3a, l\u00f4ng t\u00f3c m\u00f3ng, sinh duc…).<\/p>\n

\u2013 Thi\u1ebfu m\u00e1u m\u1ea1n:<\/p>\n

+ Xu\u1ea5t hi\u1ec7n t\u1eeb t\u1eeb v\u00e0 k\u00e9o d\u00e0i.<\/p>\n

+ C\u00f3 \u1ea3nh h\u01b0\u1edfng l\u00e2u d\u00e0i \u0111\u1ebfn nhi\u1ec1u b\u1ed9 ph\u1eadn trong c\u01a1 th\u1ec3 m\u00e0 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn huy\u1ebft \u0111\u1ed9ng.<\/p>\n

\u2013 Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng:<\/p>\n

Thi\u1ebfu m\u00e1u c\u1ea5p<\/p>\n

Thi\u1ebfu m\u00e1u m\u1ea1n<\/p>\n

Da, ni\u00eam m\u1ea1c<\/p>\n

Da xanh, ni\u00eam m\u1ea1c nh\u1ee3t<\/p>\n

Da xanh t\u1eeb t\u1eeb, ni\u00eam m\u1ea1c nh\u1ee3t<\/p>\n

B\u00e0n tay<\/p>\n

Long b\u00e0n tay tr\u1eafng b\u1ec7ch<\/p>\n

M\u00f3ng tay khum, kh\u00f4 v\u00e0 d\u1ec5 g\u1eaby<\/p>\n

Tim<\/p>\n

Nh\u1ecbp nhanh, c\u00f3 th\u1ec3 c\u00f3 ti\u1ebfng th\u1ed5i t\u00e2m thu thi\u1ebfu m\u00e1u<\/p>\n

Nh\u1ecbp nhanh, c\u00f3 ti\u1ebfng th\u1ed5i t\u00e2m thu thi\u1ebfu m\u00e1u<\/p>\n

HA<\/p>\n

T\u1ee5t ho\u1eb7c k\u1eb9p<\/p>\n

B\u00ecnh th\u01b0\u1eddng<\/p>\n

H\u00f4 h\u1ea5p<\/p>\n

Kh\u00f3 th\u1edf, nh\u1ecbp th\u1edf nhanh<\/p>\n

Kh\u00f3 th\u1edf khi ng\u1eafng s\u1ee9c, nh\u1ecbp th\u1edf nhanh<\/p>\n

Th\u1ea7n kinh<\/p>\n

\u0110au \u0111\u1ea7u, hoa m\u1eaft, ch\u00f3ng m\u1eb7t, \u00f9 tai<\/p>\n

\u0110au \u0111\u1ea7u, hoa m\u1eaft, ch\u00f3ng m\u1eb7t, \u00f9 tai<\/p>\n

C\u01a1 kh\u1edbp<\/p>\n

M\u1ecfi c\u01a1, \u0111i l\u1ea1i kh\u00f3 kh\u0103n<\/p>\n

M\u1ec7t m\u1ecfi khi \u0111i l\u1ea1i, l\u00e0m vi\u1ec7c<\/p>\n

Ti\u00eau h\u00f3a<\/p>\n

Ch\u01b0a c\u00f3 bi\u1ec3u hi\u1ec7n<\/p>\n

\u0103n k\u00e9m, ti\u00eau l\u1ecfng ho\u1eb7c t\u00e1o b\u00f3n<\/p>\n

Sinh d\u1ee5c<\/p>\n

Ch\u01b0a c\u00f3 bi\u1ec3u hi\u1ec7n<\/p>\n

N\u1eef: R\u1ed1i lo\u1ea1n kinh nguy\u1ec7t<\/p>\n

Nam: sinh l\u00fd k\u00e9m ho\u1eb7c m\u1ea5t<\/p>\n

H\u1ed3ng c\u1ea5u l\u01b0\u1edbi<\/p>\n

T\u0103ng nhi\u1ec1u<\/p>\n

T\u0103ng \u00edt, b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m<\/p>\n

C\u00e2u 39: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a v\u00e0 c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y xu\u1ea5t huy\u1ebft?<\/p>\n

I. \u0110\u1ecbnh ngh\u0129a: Xu\u1ea5t huy\u1ebft l\u00e0 t\u00ecnh tr\u1ea1ng m\u00e1u tho\u00e1t ra kh\u1ecfi th\u00e0nh m\u1ea1ch do v\u1ee1 m\u1ea1ch hay kh\u00f4ng do v\u1ee1 m\u1ea1ch (t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch)<\/p>\n

II. Nguy\u00ean nh\u00e2n: c\u00f3 3 nh\u00f3m nguy\u00ean nh\u00e2n.<\/p>\n

1. Xu\u1ea5t huy\u1ebft do th\u00e0nh m\u1ea1ch b\u1ecb t\u1ed5n th\u01b0\u01a1ng:<\/p>\n

Th\u00e0nh m\u1ea1ch b\u1ecb t\u1ed5n th\u01b0\u01a1ng do c\u00e1c nguy\u00ean nh\u00e2n sau:<\/p>\n

– C\u00e1c b\u1ec7nh nhi\u1ec5m khu\u1ea9n:nhi\u1ec5m khu\u1ea9n huy\u1ebft do n\u00e3o m\u00f4 c\u1ea7u, s\u1ed1t xu\u1ea5t huy\u1ebft, th\u01b0\u01a1ng h\u00e0n, b\u1ea1ch h\u1ea7u, s\u1edfi, nhi\u1ec5m li\u00ean c\u1ea7u, ph\u1ebf c\u1ea7u, lao c\u1ea5p t\u00ednh\u2026<\/p>\n

– Nhi\u1ec5m \u0111\u1ed9c: do thu\u1ed1c<\/p>\n

ur\u00ea m\u00e1u cao\u2026<\/p>\n

– D\u1ecb \u1ee9ng:Do th\u1ee9c \u0103n<\/p>\n

Vi\u00eam mao m\u1ea1ch d\u1ecb \u1ee9ng (b\u1ec7nh Schonlein \u2013 Henoch, v\u1edbi xu\u1ea5t huy\u1ebft th\u01b0\u1eddng d\u1ea1ng ch\u1ea5m ho\u1eb7c n\u1ed1t, \u1edf m\u1eb7t tr\u01b0\u1edbc c\u1eb3ng ch\u00e2n, \u0111\u1ed1i x\u1ee9ng 2 b\u00ean).<\/p>\n

– Ch\u1ea5n th\u01b0\u01a1ng m\u1ea1nh.<\/p>\n

– Th\u00e0nh m\u1ea1ch y\u1ebfu, d\u1ec5 v\u1ee1:<\/p>\n

+ G\u1eb7p \u1edf ng\u01b0\u1eddi gi\u00e0, ng\u01b0\u1eddi m\u1eafc c\u00e1c b\u1ec7nh m\u1ea1n t\u00ednh nh\u01b0 t\u0103ng HA, ti\u1ec3u \u0111\u01b0\u1eddng, x\u01a1 gan, lao m\u1ea1n t\u00ednh<\/p>\n

+ Ho\u1eb7c do thi\u1ebfu vitamin C, vitamin PP\u2026<\/p>\n

2. Nh\u00f3m nguy\u00ean nh\u00e2n do ti\u1ec3u c\u1ea7u: hay g\u1eb7p nh\u1ea5t, bao g\u1ed3m c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y gi\u1ea3m v\u1ec1 s\u1ed1 l\u01b0\u1ee3ng ho\u1eb7c ch\u1ea5t l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u.<\/p>\n

v Gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u: s.lg ti\u1ec3u c\u1ea7u gi\u1ea3m <100.000\/mm3 \u1edf tr\u1ebb em v\u00e0 <150.000\/mm3 \u1edf ng l\u1edbn. – Do gi\u1ea3m s\u1ea3n xu\u1ea5t ti\u1ec3u c\u1ea7u \u1edf tu\u1ef7 ho\u1eb7c tu\u1ef7 s\u1ea3n xu\u1ea5t ti\u1ec3u c\u1ea7u kh\u00f4ng hi\u1ec7u qu\u1ea3: g\u1ed3m suy tu\u1ef7, leucemia, u \u00e1c t\u00ednh x\u00e2m l\u1ea5n tu\u1ef7, \u1ee9c ch\u1ebf t\u1ef7 sau x\u1ea1 tr\u1ecb, ho\u00e1 tr\u1ecb\u2026 – Do t\u0103ng ti\u00eau th\u1ee5 ti\u1ec3u c\u1ea7u \u1edf m\u00e1u ngo\u1ea1i vi: + Do kh\u00e1ng th\u1ec3 kh\u00e1ng ti\u1ec3u c\u1ea7u: ..Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u t\u1ef1 mi\u1ec5n (b\u1ec7nh Werlhoff) ..Nhi\u1ec5m khu\u1ea9n: S\u1ed1t xu\u1ea5t huy\u1ebft, s\u1ed1t r\u00e9t, nhi\u1ec5m tr\u00f9ng huy\u1ebft, th\u01b0\u01a1ng h\u00e0n, Osler\u2026 ..Xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u \u0111\u1ed3ng mi\u1ec5n d\u1ecbch \u1edf m\u1eb9 v\u00e0 con ..B\u1ec7nh ph\u1ed1i h\u1ee3p: Lupus ban \u0111\u1ecf r\u1ea3i r\u00e1c, leucemia kinh d\u00f2ng lympho\u2026 ..Nhi\u1ec5m \u0111\u1ed9c v\u00e0 d\u1ecb \u1ee9ng: thu\u1ed1c v\u00e0 ho\u00e1 ch\u1ea5t (Quinin, Quinidin, Phenol-barbital\u2026);tia x\u1ea1 (tia X, c\u00e1c \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1); n\u1ecdc r\u1eafn, n\u1ecdc c\u00f4n tr\u00f9ng\u2026 + Kh\u00f4ng do kh\u00e1ng th\u1ec3 kh\u00e1ng ti\u1ec3u c\u1ea7u: gi\u1ea3m ti\u1ec3u c\u1ea7u \u1edf b\u1ec7nh nh\u00e2n l\u1eafp van tim nh\u00e2n t\u1ea1o, b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh tim b\u1ea9m sinh hay m\u1eafc ph\u1ea3i. + Do t\u0103ng b\u1eaft gi\u1eef ti\u1ec3u c\u1ea7u \u1edf ngo\u1ea1i vi: c\u01b0\u1eddng l\u00e1ch. + H\u1ed9i ch\u1ee9ng ph\u1ed1i h\u1ee3p s\u1ef1 ti\u00eau th\u1ee5 ti\u1ec3u c\u1ea7u v\u00e0 fibrinogen: \u0111\u00f4ng m\u00e1u n\u1ed9i m\u1ea1ch r\u1ea3i r\u00e1c. + C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c: ng\u1ea1t sau sinh, b\u1ea5t \u0111\u1ed3ng h\u1ec7 nh\u00f3m m\u00e1u Rh \u1edf tr\u1ebb s\u01a1 sinh, b\u1ecfng r\u1ed9ng\u2026 v Gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u: – Suy nh\u01b0\u1ee3c ti\u1ec3u c\u1ea7u: b\u1ec7nh Glanzmann. – Lo\u1ea1n d\u01b0\u1ee1ng ti\u1ec3u c\u1ea7u: b\u1ec7nh Tean-Bernard-Soulier. – Gi\u1ea3m ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u t\u1ea1m th\u1eddi do thu\u1ed1c: Aspyrin, kh\u00e1ng vi\u00eam non-steroid, thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng\u2026 3. Nh\u00f3m nguy\u00ean nh\u00e2n do huy\u1ebft t\u01b0\u01a1ng: nh\u00f3m n\u00e0y hi\u1ebfm g\u1eb7p, bao g\u1ed3m: v [\u200bIMG]R\u1ed1i lo\u1ea1n sinh Thromboplastin thi\u1ebfu Thromboplastin: b\u1ec7nh \u01b0a ch\u1ea3y m\u00e1u(Hemophilie) g\u1ed3m c\u00f3 Hemophilie A(thi\u1ebfu y\u1ebfu t\u1ed1 VIII),Hemophilie B (thi\u1ebfu y\u1ebfu t\u1ed1 IX),Hemophilie C(thi\u1ebfu y\u1ebfu t\u1ed1 XI). v R\u1ed1i lo\u1ea1n sinh Prothrombin d\u1eabn \u0111\u1ebfn thi\u1ebfu Prothrombin: – B\u1ea9m sinh: thi\u1ebfu y\u1ebfu t\u1ed1 II, V, VII, X. – M\u1eafc ph\u1ea3i: suy gan, t\u1eafc m\u1eadt, thi\u1ebfu vitamin K. v R\u1ed1i lo\u1ea1n sinh Fibrinogen d\u1eabn \u0111\u1ebfn thi\u1ebfu Fibrin: – B\u1ea5t th\u01b0\u1eddng h\u1ec7 th\u1ed1ng t\u1ed5ng h\u1ee3p: suy gan n\u1eb7ng, b\u1ea9m sinh kh\u00f4ng c\u00f3 fibrinogen. – Fibrinogen b\u1ecb ph\u00e1 hu\u1ef7 nhi\u1ec1u: h\u1ed9i ch\u1ee9ng \u0111\u00f4ng m\u00e1u n\u1ed9i m\u1ea1ch r\u1ea3i r\u00e1c (DIC), ch\u1ea5n th\u01b0\u01a1ng, b\u1ecfng n\u1eb7ng. – Nguy\u00ean nh\u00e2n kh\u00e1c: tai bi\u1ebfn truy\u1ec1n m\u00e1u, b\u1ec7nh Vaquez, nhi\u1ec5m khu\u1ea9n Gram (-), ung th\u01b0 \u1ed1ng ti\u00eau ho\u00e1 di c\u0103n, leucemia c\u1ea5p th\u1ec3 L3, tai bi\u1ebfn \u0111i\u1ec1u tr\u1ecb t\u1eafc m\u1ea1ch, r\u1eafn c\u1eafn\u2026 v C\u00f3 ch\u1ea5t kh\u00e1ng \u0111\u00f4ng l\u01b0u h\u00e0nh: – Sau khi ti\u00eam nhi\u1ec1u Heparin. – C\u01a1 th\u1ec3 t\u1ea1o ra nhi\u1ec1u Heparin sau khi shock ho\u1eb7c sau khi chi\u1ebfu c\u00e1c tia x\u1ea1\u2026 C\u00e2u 40: Tr\u00ecnh b\u00e0y c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng c\u1ee7a xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da ? I. L\u00e2m s\u00e0ng: 1. C\u00e1ch xu\u1ea5t hi\u1ec7n: + T\u1ef1 nhi\u00ean hay th\u1ee9 ph\u00e1t sau sang ch\u1ea5n? + Ti\u1ec1n s\u1eed c\u00f3 xu\u1ea5t huy\u1ebft l\u1eb7p \u0111i l\u1eb7p l\u1ea1i tr\u01b0\u1edbc \u0111\u00f3? 2. V\u1ecb tr\u00ed xu\u1ea5t huy\u1ebft: – Xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da ch\u1ec9 c\u00f3 \u1edf t\u1ee9 chi \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf c\u1eb3ng ch\u00e2n th\u01b0\u1eddng g\u1eb7p trong vi\u00eam th\u00e0nh m\u1ea1ch d\u1ecb \u1ee9ng. – Xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da g\u1eb7p \u1edf c\u1ea3 t\u1ee9 chi, th\u00e2n m\u00ecnh v\u00e0 c\u1ea3 \u1edf \u0111\u1ea7u, m\u1eb7t, th\u01b0\u1eddng g\u1eb7p trong b\u1ec7nh l\u00fd ti\u1ec3u c\u1ea7u ho\u1eb7c r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u. 3. H\u00ecnh th\u00e1i xu\u1ea5t huy\u1ebft: Nhi\u1ec1u h\u00ecnh th\u00e1i: + Ch\u1ea5m xu\u1ea5t huy\u1ebft: B\u1eb1ng \u0111\u1ea7u t\u0103m. + N\u1ed1t xu\u1ea5t huy\u1ebft: K\u00edch th\u01b0\u1edbc 1-10mm. + M\u1ea3ng xu\u1ea5t huy\u1ebft: K\u00edch th\u01b0\u1edbc 1-10cm. + Kh\u1ed1i m\u00e1u t\u1ee5: To, n\u1ed5i c\u1ee5c d\u01b0\u1edbi da. + \u0110\u00e1m xu\u1ea5t huy\u1ebft: T\u1eadp trung nhi\u1ec1u ch\u1ea5m, n\u1ed1t, m\u1ea3ng h\u1ee3p l\u1ea1i t\u1ea1o ra m\u00e0u s\u1eafc kh\u00e1c nhau. + V\u1ec7t xu\u1ea5t huy\u1ebft: Xu\u1ea5t huy\u1ebft t\u1eadp trung \u1edf c\u00e1c v\u1ecb tr\u00ed nh\u01b0 khu\u1ef7u tay, khoeo ch\u00e2n. 4. T\u00ednh ch\u1ea5t c\u1ee7a xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da: – Xu\u1ea5t huy\u1ebft \u0111\u1ed1i x\u1ee9ng hai b\u00ean l\u00e0 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a vi\u00eam th\u00e0nh m\u1ea1ch d\u1ecb \u1ee9ng. – M\u00e0u s\u1eafc c\u00e1c n\u1ed1t, m\u1ea3ng xu\u1ea5t huy\u1ebft \u0111\u1ed3ng \u0111\u1ec1u n\u00f3i l\u00ean t\u00ednh ch\u1ea5t c\u1ea5p t\u00ednh ho\u1eb7c m\u1edbi m\u1eafc, m\u00e0u s\u1eafc kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u n\u00f3i l\u00ean t\u00ednh ch\u1ea5t m\u1ea1n t\u00ednh. 5. S\u1ed1 l\u01b0\u1ee3ng xu\u1ea5t huy\u1ebft: \u00cdt hay nhi\u1ec1u. II. C\u1eadn l\u00e2m s\u00e0ng: 1. C\u1eadn l\u00e2m s\u00e0ng gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh xu\u1ea5t huy\u1ebft: C\u00f3 khi c\u1ea7n x\u00e9t nghi\u1ec7m t\u00ecm h\u1ed3ng c\u1ea7u trong c\u00e1c d\u1ecbch, n\u1ed9i soi \u0111\u01b0\u1eddng ti\u00eau ho\u00e1\u2026 2. C\u1eadn l\u00e2m s\u00e0ng gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng nh\u00f3m nguy\u00ean nh\u00e2n xu\u1ea5t huy\u1ebft v\u00e0 t\u00ecm nguy\u00ean nh\u00e2n xu\u1ea5t huy\u1ebft a. C\u1eadn l\u00e2m s\u00e0ng \u0111\u1ecbnh h\u01b0\u1edbng nh\u00f3m nguy\u00ean nh\u00e2n xu\u1ea5t huy\u1ebft: – Th\u00e0nh m\u1ea1ch: D\u1ea5u hi\u1ec7u Lacet, nghi\u1ec7m ph\u00e1p gi\u00e1c h\u00fat. + Nghi\u1ec7m ph\u00e1p d\u00e2y th\u1eaft (\u00e1p l\u1ef1c d\u01b0\u01a1ng): \u00b7 Ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfn h\u00e0nh: d\u00f9ng huy\u1ebft \u00e1p k\u1ebf \u0111\u1eb7t tr\u00ean c\u00e1nh tay v\u1edbi \u00e1p l\u1ef1c trung b\u00ecnh (huy\u1ebft \u00e1p t\u1ed1i \u0111a x 2 + huy\u1ebft \u00e1p t\u1ed1i thi\u1ec3u)\/3, duy tr\u00ec \u00e1p l\u1ef1c n\u00e0y trong 10 ph\u00fat sau \u0111\u00f3 th\u00e1o h\u01a1i nhanh v\u00e0 b\u1ecf huy\u1ebft \u00e1p k\u1ebf ra, quan s\u00e1t c\u00e1nh tay v\u00e0 c\u1eb3ng tay ph\u1ea7n d\u01b0\u1edbi d\u00e2y th\u1eaft. \u00b7 \u0110\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3: nghi\u1ec7m ph\u00e1p (+) khi c\u00f3 > 5 ch\u1ea5m xu\u1ea5t huy\u1ebft\/1cm2 da.<\/p>\n

+ Nghi\u1ec7m ph\u00e1p gi\u00e1c h\u00fat (\u00e1p l\u1ef1c \u00e2m): ph\u1ea3i c\u00f3 m\u00e1y chuy\u00ean d\u1ee5ng. \u0110\u1eb7t gi\u00e1c h\u00fat v\u00e0o v\u00f9ng da m\u1ecfng \u1edf c\u00e1nh tay, c\u1eb3ng tay v\u1edbi \u00e1p l\u1ef1c t\u0103ng d\u1ea7n \u0111\u1ebfn khi n\u00e0o b\u1eaft \u0111\u1ea7u xu\u1ea5t hi\u1ec7n n\u1ed1t xu\u1ea5t huy\u1ebft th\u00ec ng\u1eebng. C\u01b0\u1eddng \u0111\u1ed9 \u00e1p l\u1ef1c \u1edf th\u1eddi \u0111i\u1ec3m \u0111\u00f3 t\u01b0\u01a1ng \u1ee9ng v\u1edbi s\u1ee9c b\u1ec1n th\u00e0nh m\u1ea1ch. B\u00ecnh th\u01b0\u1eddng s\u1ee9c b\u1ec1n th\u00e0nh m\u1ea1ch kho\u1ea3ng 20cmHg. N\u1ebfu d\u01b0\u1edbi 15cmHg l\u00e0 s\u1ee9c b\u1ec1n th\u00e0nh m\u1ea1ch gi\u1ea3m.<\/p>\n

– Ti\u1ec3u c\u1ea7u: D\u1ea5u hi\u1ec7u Lacet, s\u1ed1 l\u01b0\u1ee3ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u, th\u1eddi gian m\u00e1u ch\u1ea3y, th\u1eddi gian co c\u1ee5c m\u00e1u.<\/p>\n

– Huy\u1ebft t\u01b0\u01a1ng: Th\u1eddi gian m\u00e1u \u0111\u00f4ng, th\u1eddi gian Howell, th\u1eddi gian Quick, th\u1eddi gian Cephalin-Kaolin, \u0111\u1ecbnh l\u01b0\u1ee3ng fibrinogen\u2026<\/p>\n

b. C\u1eadn l\u00e2m s\u00e0ng gi\u00fap t\u00ecm nguy\u00ean nh\u00e2n xu\u1ea5t huy\u1ebft: Tu\u1ef3 theo nguy\u00ean nh\u00e2n kh\u00e1c nhau m\u00e0 c\u00f3 c\u1eadn l\u00e2m s\u00e0ng th\u00edch h\u1ee3p.<\/p>\n

3. C\u1eadn l\u00e2m s\u00e0ng x\u00e1c \u0111\u1ecbnh h\u1eadu qu\u1ea3 c\u1ee7a h\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft g\u00e2y ra:<\/p>\n

– H\u1ed9i ch\u1ee9ng thi\u1ebfu m\u00e1u: HC, Hct, Hb<\/p>\n

– Xu\u1ea5t huy\u1ebft c\u00e1c t\u1ea1ng.<\/p>\n

C\u00e2u 41: Tr\u00ecnh b\u00e0y c\u00e1c b\u01b0\u1edbc th\u0103m kh\u00e1m th\u1ef1c th\u1ec3 th\u1eadn ?<\/p>\n

I. Kh\u00e1m to\u00e0n th\u00e2n:<\/p>\n

– Ph\u00e1t hi\u1ec7n s\u1ed1t: + s\u1ed1t cao , r\u00e9t run g\u1eb7p trong vi\u00eam th\u1eadn b\u1ec3 th\u1eadn<\/p>\n

+ s\u1ed1t nhi\u1ec1u ng\u00e0y g\u1eb7p trong th\u1eadn \u1ee9 m\u1ee7<\/p>\n

+ s\u1ed1t k\u00e9o d\u00e0i g\u1eb7p trong vi\u00eam th\u1eadn lupus\u2026.<\/p>\n

– Ph\u00e1t hi\u1ec7n thi\u1ebfu m\u00e1u: da xanh ni\u00eam m\u0103c nh\u1ee3t, b\u00e0n tay m\u00f3ng tay m\u1ea5t m\u00e0u h\u1ed3ng\u2026\u2026.<\/p>\n

– Ph\u00e1t hi\u1ec7n ph\u00f9:ph\u00f9 tr\u1eafng \u1ea5n l\u00f5m, th\u01b0\u1eddng ph\u00f9 m\u1eb7t tr\u01b0\u1edbc \u0111\u1ebfn chi v\u00e0 to\u00e0n th\u00e2n<\/p>\n

– Ph\u00e1t hi\u1ec7n t\u0103ng huy\u1ebft \u00e1p: 80% b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh c\u1ea7u th\u1eadn c\u00f3 t\u0103ng HA<\/p>\n

– Ph\u00e1t hi\u1ec7n suy tim: b\u1ec7nh th\u1eadn m\u00e3n t\u00ednh c\u00f3 suy th\u1eadn th\u01b0\u1eddng c\u00f3 suy tim do thi\u1ebfu m\u00e1u<\/p>\n

II. Kh\u00e1m th\u1eadn:<\/p>\n

– Nh\u00ecn:<\/p>\n

+ T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n ng\u1ed3i, l\u01b0ng c\u00e2n \u0111\u1ed1i v\u00e0 quay v\u1ec1 ph\u00eda th\u1ea7y thu\u1ed1c: quan s\u00e1t 2 b\u00ean h\u1ed1 l\u01b0ng c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n th\u1ea5y \u0111\u1ea7y l\u00ean m\u1ed9t b\u00ean ho\u1eb7c hai b\u00ean, bi\u1ec3u hi\u1ec7n c\u1ee7a th\u1eadn to.<\/p>\n

+ T\u01b0 th\u1ebf BN n\u1eb1m ng\u1eeda, th\u1ea7y thu\u1ed1c quan s\u00e1t v\u00f9ng h\u1ea1 s\u01b0\u1eddn ph\u1ea3i, v\u00f9ng h\u00f4ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n kh\u1ed1i u. . .<\/p>\n

– S\u1edd : C\u00f3 3 ph\u1eeb\u01a1ng ph\u00e1p th\u01b0\u1eddng d\u00f9ng:<\/p>\n

+ Ph\u01b0\u01a1ng ph\u00e1p Guyon:<\/p>\n

Th\u00f4ng th\u01b0\u1eddng nh\u1ea5t, B\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda, hai ch\u00e2n co, th\u1edf \u0111\u1ec1u, th\u1ea7y thu\u1ed1c ng\u1ed3i b\u00ean th\u1eadn \u0111\u1ecbnh kh\u00e1m b\u00e0n tay c\u00f9ng b\u00ean \u0111\u1eb7t l\u00ean v\u00f9ng h\u00f4ng ph\u00eda tr\u01b0\u1edbc (d\u01b0\u1edbi b\u1edd s\u01b0\u1eddn, tr\u00ean r\u1ed1n) c\u00e1c \u0111\u1ea7u ng\u00f3n tay h\u01b0\u1edbng v\u00e0o kh\u1ed1i c\u01a1 th\u1eb3ng b\u1ee5ng \u1ea5n xu\u1ed1ng, b\u00e0n tay kia \u0111\u1eb7t d\u01b0\u1edbi h\u1ed1 l\u01b0ng.<\/p>\n

\u00b7 T\u00ecm d\u1ea5u hi\u1ec7u ch\u1ea1m th\u1eadn : B\u00e0n tay d\u01b0\u1edbi \u0111\u1ec3 y\u00ean, b\u00e0n tay ph\u00eda tr\u00ean b\u1ee5ng \u1ea5n xu\u1ed1ng theo nh\u1ecbp th\u1edf\u00ae b\u00e0n tay \u0111\u1eb7t \u1edf d\u01b0\u1edbi h\u1ed1 l\u01b0ng c\u00f3 th\u1ec3 c\u00f3 c\u1ea3m gi\u00e1c ch\u1ea1m v\u00e0o m\u1ed9t kh\u1ed1i \u0111\u1eb7c.<\/p>\n

K\u1ebft lu\u1eadn: D\u1ea5u hi\u1ec7u ch\u1ea1m th\u1eadn (+).<\/p>\n

\u00b7 T\u00ecm d\u1ea5u hi\u1ec7u b\u1eadp b\u1ec1nh th\u1eadn : B\u00e0n tay th\u1ea7y thu\u1ed1c \u0111\u1eb7t tr\u00ean b\u1ee5ng v\u00f9ng h\u00f4ng \u1ea5n xu\u1ed1ng nh\u1eb9 r\u1ed3i \u0111\u1ec3 y\u00ean. D\u00f9ng c\u00e1c ng\u00f3n tay c\u1ee7a b\u00e0n tay ph\u00eda d\u01b0\u1edbi \u1ea5n \u0111\u1ea9y h\u1ea5t m\u1ea1nh l\u00ean v\u00e0 l\u00e0m ng\u01b0\u1ee3c l\u1ea1i. \u0110\u1ed9ng t\u00e1c \u1ea5n \u0111\u1ea9y c\u1ea7n d\u1ee9t kho\u00e1t, l\u00e0m nhi\u1ec1u l\u1ea7n. Khi c\u00f3 th\u1eadn to hai b\u00e0n tay c\u00f3 c\u1ea3m gi\u00e1c ch\u1ea1m v\u00e0o m\u1ed9t kh\u1ed1i ch\u1eafc b\u1eadp b\u1ec1nh \u00ae K\u1ebft lu\u1eadn: D\u1ea5u hi\u1ec7u b\u1eadp b\u1ec1nh th\u1eadn (+)<\/p>\n

+ Ph\u01b0\u01a1ng ph\u00e1p Israel:<\/p>\n

B\u1ec7nh nh\u00e2n n\u1eb1m nghi\u00eang b\u00ean \u0111\u1ed1i di\u1ec7n v\u00e0 kh\u00e1m nh\u01b0 ph\u01b0\u01a1ng ph\u00e1p Guyon.<\/p>\n

+ Ph\u01b0\u01a1ng ph\u00e1p Glenard:<\/p>\n

D\u00f9ng b\u00e0n tay \u0111\u1ed1i di\u1ec7n v\u1edbi th\u1eadn \u0111\u1ecbnh kh\u00e1m, ng\u00f3n tay c\u00e1i \u0111\u1ec3 tr\u00ean b\u1ee5ng, b\u1ed1n ng\u00f3n kia \u0111\u1ec3 ph\u00eda sau v\u00e0 b\u00f3p ch\u1eb7t v\u00f9ng th\u1eaft l\u01b0ng \u00ae N\u1ebfu th\u1eadn to th\u00ec khi th\u1edf th\u1ea5y c\u1ea3m gi\u00e1c th\u1eadn di \u0111\u1ed9ng trong l\u00f2ng b\u00e0n tay.<\/p>\n

– G\u00f5:<\/p>\n

Th\u1eadn to khi g\u00f5 nghe ti\u1ebfng trong do c\u00f3 \u0111\u1ea1i tr\u00e0ng che ph\u1ee7 (ph\u00e2n bi\u1ec7t v\u1edbi gan, l\u00e1ch).<\/p>\n

– Nghe:<\/p>\n

Ti\u1ebfng th\u1ed5i t\u00e2m thu tr\u00ean r\u1ed1n b\u00ean tr\u00e1i ho\u1eb7c b\u00ean ph\u1ea3i c\u1ee7a h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn.<\/p>\n

C\u00e2u 42 : Tr\u00ecnh b\u00e0y v\u1ecb tr\u00ed v\u00e0 c\u00e1ch th\u0103m kh\u00e1m c\u00e1c \u0111i\u1ec3m \u0111au ni\u1ec7u qu\u1ea3n v\u00e0 c\u00e1c \u0111i\u1ec3m \u0111au c\u1ee7a th\u1eadn ?<\/p>\n

1. \u0110i\u1ec3m \u0111au ni\u1ec7u qu\u1ea3n tr\u00ean (\u0111i\u1ec3m c\u1ea1nh r\u1ed1n): K\u1ebb m\u1ed9t \u0111\u01b0\u1eddng ngang r\u1ed1n, g\u1eb7p b\u1edd ngo\u00e0i c\u01a1 th\u1eb3ng to ho\u1eb7c c\u00e1ch r\u1ed1n 3 kho\u00e1t ng\u00f3n tay (t\u01b0\u01a1ng \u1ee9ng L2 l\u00e0 \u0111i\u1ec3m n\u1ed1i b\u1ec3 th\u1eadn v\u00e0 ni\u1ec7u qu\u1ea3n). Khi kh\u00e1m th\u1ea7y thu\u1ed1c ng\u1ed3i b\u00ean ph\u1ea3i b\u1ec7nh nh\u00e2n, d\u00f9ng tay tr\u00e1i \u0111\u1ee1 h\u00f4ng l\u01b0ng, d\u00f9ng 3 ng\u00f3n c\u1ee7a b\u00e0n tay ph\u1ea3i (ng\u00f3n 2, 3, 4) \u1ea5n nh\u1eb9 t\u1eeb tr\u01b0\u1edbc b\u1ee5ng ra sau l\u01b0ng, c\u00e1c ng\u00f3n tay \u0111\u1eb7t song song v\u1edbi b\u1edd ngo\u00e0i c\u01a1 th\u1eb3ng to v\u1eeba \u1ea5n v\u1eeba quan s\u00e1t n\u00e9t m\u1eb7t c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ec3 ph\u00e1t hi\u1ec7n tri\u1ec7u ch\u1ee9ng \u0111au. Th\u01b0\u1eddng g\u1eb7p trong s\u1ecfi b\u1ec3 th\u1eadn.<\/p>\n

2. \u0110i\u1ec3m ni\u1ec7u qu\u1ea3n gi\u1eefa: K\u1ebb \u0111\u01b0\u1eddng ngang qua hai gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean, chia 3 ph\u1ea7n, \u0111i\u1ec3m n\u1ed1i 1\/3 gi\u1eefa v\u00e0 1\/3 ngo\u00e0i t\u01b0\u01a1ng \u1ee9ng v\u1edbi \u0111i\u1ec3m ni\u1ec7u qu\u1ea3n gi\u1eefa (t\u01b0\u01a1ng \u1ee9ng L4 – L5). C\u00e1ch kh\u00e1m t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1ch kh\u00e1m \u0111i\u1ec3m ni\u1ec7u qu\u1ea3n tr\u00ean.<\/p>\n

3. \u0110i\u1ec3m ni\u1ec7u qu\u1ea3n d\u01b0\u1edbi: ph\u1ea3i th\u0103m tr\u1ef1c tr\u00e0ng v\u00e0 \u00e2 m \u0111 \u1ea1 o m\u1edbi th\u1ea5y<\/p>\n

4. \u0110i\u1ec3m \u0111au h\u1ed1 s\u01b0\u1eddn (\u0111i\u1ec3m s\u01b0\u1eddn l\u01b0ng):Ch\u1ed7 g\u1eb7p nhau c\u1ee7a b\u1edd d\u01b0\u1edbi x\u01b0\u01a1ng s\u01b0\u1eddn XII v\u00e0 b\u1edd ngo\u00e0i kh\u1ed1i c\u01a1 l\u01b0ng. T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n gi\u1ed1ng nh\u01b0 kh\u00e1m th\u1eadn. D\u00f9ng 3 ng\u00f3n tay c\u1ee7a b\u00e0n tay \u1ea5n v\u00e0o h\u1ed1 s\u01b0\u1eddn l\u01b0ng, b\u00e0n tay tr\u00ean k\u1ebft h\u1ee3p \u1ea5n xu\u1ed1ng, n\u1ebfu c\u00f3 \u0111au l\u00e0 (+), th\u01b0\u1eddng g\u1eb7p trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 s\u1ecfi th\u1eadn, th\u1eadn \u1ee9 m\u1ee7, th\u1eadn \u0111a nang, th\u1eadn \u1ee9 n\u01b0\u1edbc, vi\u00eam t\u1ea5y quanh th\u1eadn, vi\u00eam th\u1eadn b\u1ec3 th\u1eadn c\u1ea5p. . . (Ch\u00fa \u00fd ph\u00e2n bi\u1ec7t v\u1edbi vi\u00eam tu\u1ef5 c\u1ea5p)<\/p>\n

5.\u0110i\u1ec3m s\u01b0\u1eddn s\u1ed1ng: l\u00e0 giao \u0111i\u1ec3m x\u01b0\u01a1ng s\u01b0\u1eddn th\u1ee9 12 v\u00e0 m\u1ecfm ngang \u0111\u1ed1t s\u1ed1ng l\u01b0ng th\u1ee9 12 (\u0111i\u1ec3m Mayo-Robson), \u0111au g\u1eb7p trong vi\u00eamt\u1ee5y c\u1ea5p, vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn c\u1ea5p<\/p>\n

Ngo\u00e0i ra ng\u01b0\u1eddi ta c\u00f2n l\u00e0m th\u00eam ph\u01b0\u01a1ng ph\u00e1p v\u1ed7 th\u1eadn \u0111\u1ec3 t\u00ecm d\u1ea5u hi\u1ec7u rung th\u1eadn gi\u1ed1ng nh\u01b0 d\u1ea5u hi\u1ec7u rung gan; \u0111\u1ec3 m\u1ed9t b\u00e0n tay l\u00ean v\u00f9ng th\u1eadn r\u1ed3i d\u00f9ng m\u00e9p b\u00e0n tay kia v\u1ed7 l\u00ean tr\u00ean. B\u00ecnh th\u01b0\u1eddng, khi l\u00e0m nghi\u1ec7m ph\u00e1p n\u00e0y, ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng \u0111au, nh\u01b0ng n\u1ebfu c\u00f3 b\u1ec7nh l\u00fd \u1edf th\u1eadn, nh\u1ea5t l\u00e0 \u1ee9 n\u01b0\u1edbc v\u00e0 \u1ee9 m\u1ee7 th\u1eadn l\u00e0m nghi\u1ec7m ph\u00e1p n\u00e0y r\u1ea5t \u0111au.<\/p>\n

C\u00e2u 58: Tr\u00ecnh b\u00e0y \u0111\u01b0\u1ee3c c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y th\u1eadn to?<\/p>\n

1 \u1ee8 n\u01b0\u1edbc, \u1ee9 m\u1ee7 b\u1ec3 th\u1eadn:<\/p>\n

– S\u1ecfi th\u1eadn, s\u1ecfi ni\u1ec7u qu\u1ea3n.<\/p>\n

– Thai, kh\u00f4\u00ed u trong \u1ed5 b\u1ee5ng \u0111\u00e8 v\u00e0o ni\u1ec7u qu\u1ea3n.<\/p>\n

– Lao b\u1ec3 th\u1eadn, ni\u1ec7u qu\u1ea3n l\u00e0m h\u1eb9p l\u00f2ng ni\u1ec7u qu\u1ea3n.<\/p>\n

– B\u00ed \u0111\u00e1i l\u00e2u ng\u00e0y do u ti\u1ec1n li\u1ec7t tuy\u1ebfn.<\/p>\n

2. Ung th\u01b0 th\u1eadn:<\/p>\n

– Nguy\u00ean ph\u00e1t:<\/p>\n

Th\u1eadn to, c\u1ee9ng, m\u1eb7t l\u1ed5n nh\u1ed5n.<\/p>\n

\u0110\u00e1i ra m\u00e1u t\u1ef1 nhi\u00ean hay \u0111\u00e1i ra m\u00e1u vi th\u1ec3.<\/p>\n

Xquang – Si\u00eau \u00e2m th\u1eadn: To m\u1ed9t b\u00ean, \u0111\u00e0i th\u1eadn b\u1ecb k\u00e9o d\u00e0i, c\u1eaft c\u1ee5t, l\u1ec7ch h\u01b0\u1edbng.<\/p>\n

– Th\u1ee9 ph\u00e1t: Sau K t\u1eed cung, K rau.<\/p>\n

3. Th\u1eadn \u0111a nang:<\/p>\n

– Th\u1eadn to m\u1ed9t b\u00ean ho\u1eb7c hai b\u00ean.<\/p>\n

– \u0110\u00f4i khi c\u00f3 c\u01a1n \u0111au qu\u1eb7n th\u1eadn<\/p>\n

– Khi c\u00f3 b\u1ed9i nhi\u1ec5m: \u0110\u00e1i \u0111\u1ee5c, c\u1ea5y n\u1ee9\u01a1c ti\u1ec3u c\u00f3 vi khu\u1ea9n<\/p>\n

– Ure m\u00e1u cao m\u1ea1n t\u00ednh.<\/p>\n

– XQ, SA c\u00f3 nang th\u1eadn.<\/p>\n

4. Th\u1eadn to b\u00f9.<\/p>\n

– Ch\u1ec9 c\u00f3 m\u1ed9t th\u1eadn<\/p>\n

– N\u01b0\u1edbc ti\u1ec3u b\u00ecnh th\u01b0\u1eddng.<\/p>\n

C\u00e2u 43:Tr\u00ecnh b\u00e0y c\u00e1c ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t th\u1eadn to?<\/p>\n

1 Th\u1eadn ph\u1ea3i to:<\/p>\n

– Kh\u1ed1i u c\u1ee7a gan: Di \u0111\u1ed9ng theo chi\u1ec1u l\u00ean xu\u1ed1ng, di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf<\/p>\n

Li\u1ec1n v\u1edbi b\u1edd s\u01b0\u1eddn.<\/p>\n

– T\u00fai m\u1eadt to:<\/p>\n

+ Kh\u1ed1i u m\u1ec1m nh\u1eb5n, tr\u00f2n, c\u0103ng.<\/p>\n

+ R\u1ea5t \u0111au, d\u1ea5u hi\u1ec7u Murphy(+)<\/p>\n

+ C\u00f3 th\u1ec3 v\u00e0ng da, v\u00e0ng m\u1eaft, s\u1ed1t.<\/p>\n

+ Di \u0111\u1ed9ng l\u00ean xu\u1ed1ng theo nh\u1ecbp th\u1edf,<\/p>\n

– Kh\u1ed1i u \u0111\u1ea1i tr\u00e0ng l\u00ean:<\/p>\n

+ S\u00e1t \u1edf ph\u00eda b\u1edd s\u01b0\u1eddn<\/p>\n

+ C\u00f3 h\u1ed9i ch\u1ee9ng b\u00e1n t\u1eafc ru\u1ed9t (m\u1ee9t \u0111\u1ed9 nh\u1eb9 h\u01a1n: t\u00e1o b\u00f3n li\u00ean mi\u00ean)<\/p>\n

+ Ch\u1ee5p khung \u0111\u1ea1i tr\u00e0ng s\u1ebd c\u00f3 h\u00ecnh khuy\u1ebft c\u1ee7a kh\u1ed1i u.<\/p>\n

– Kh\u1ed1i u h\u1ed3i manh tr\u00e0ng(do lao, k, am\u00edp, \u0111\u00e1m qu\u00e1nh ru\u1ed9t th\u1eeba).<\/p>\n

+ \u1ede th\u1ea5p v\u00f9ng h\u1ed1 ch\u1eadu ph\u1ea3i.<\/p>\n

+ C\u00f3 h\u1ed9i ch\u1ee9ng b\u00e1n t\u1eafc ru\u1ed9t.<\/p>\n

+ \u00cdt di \u0111\u1ed9ng, c\u00f3 t\u00ednh ch\u1ea5t d\u00ednh.<\/p>\n

– Kh\u1ed1i u \u0111\u1ea7u tu\u1ef5:<\/p>\n

+ \u1ede v\u00f9ng th\u01b0\u1ee3ng v\u1ecb v\u00e0 n\u1eb1m \u1edf ph\u00eda sau.<\/p>\n

+ Kh\u00f4ng di \u0111\u1ed9ng.<\/p>\n

+ C\u00f3 tri\u1ec7u ch\u1ee9ng t\u1eafc m\u1eadt, v\u00e0ng da, t\u00fai m\u1eadt to.<\/p>\n

2 . Th\u1eadn tr\u00e1i to: ph\u00e2n bi\u1ec7t v\u1edbi<\/p>\n

– L\u00e1ch to:<\/p>\n

+ Li\u1ec1n v\u1edbi b\u1edd s\u01b0\u1eddn.<\/p>\n

+ Di \u0111\u1ed9ng theo nhip th\u1edf.<\/p>\n

+ C\u00f3 b\u1edd r\u0103ng c\u01b0a.<\/p>\n

+ \u0110\u00f4i khi ph\u00e2n bi\u1ec7t b\u0103ng nghi\u1ec7m ph\u00e1p co l\u00e1ch: Ti\u00eam 1ml adrenalin d\u01b0\u1edbi da, n\u1ebfu l\u00e1ch to sau 30 ph\u00fat l\u00e1ch co l\u1ea1i.<\/p>\n

– Kh\u1ed1i u \u0111\u1ea1i tr\u00e0ng tr\u00e1i:<\/p>\n

+ \u1ede s\u00e1t ph\u00eda ngo\u00e0i b\u1edd s\u01b0\u1eddn tr\u00e1i.<\/p>\n

+ C\u00f3 h\u1ed9i ch\u1ee9ng \u0111\u1ea1i tr\u00e0ng v\u00e0 b\u00e1n t\u1eafc ru\u1ed9t.<\/p>\n

– Kh\u1ed1i u \u0111u\u00f4i tu\u1ef5:+ S\u00e2u \u1edf ph\u00eda sau<\/p>\n

+ Kh\u00f4ng di d\u1ed9ng<\/p>\n

+ R\u1ea5t to.<\/p>\n

3. Chung cho c\u1ea3 hai th\u1eadn:<\/p>\n

– H\u1ea1ch m\u1ea1c treo.<\/p>\n

+ Kh\u00f4ng di \u0111\u1ed9ng.<\/p>\n

+ Nhi\u1ec1u h\u1ea1ch d\u00ednh v\u1edbi nhau.<\/p>\n

– U tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn: R\u1ea5t kh\u00f3 ph\u00e2n bi\u1ec7t b\u1eb1ng th\u0103m kh\u00e1m l\u00e2m s\u00e0ng, c\u1ea7n ph\u00e2n bi\u1ec7t b\u1eb1ng si\u00eau \u00e2m, t\u1ed1t nh\u1ea5t l\u00e0 b\u1eb1ng b\u01a1m h\u01a1i sau m\u00e0ng b\u1ee5ng<\/p>\n

– U nang bu\u1ed3ng tr\u1ee9ng ph\u1ea3i v\u00e0 tr\u00e1i:<\/p>\n

+ Kh\u1ed1i u tr\u00f2n nh\u1eb5n<\/p>\n

+ N\u1eb1m \u1edf hai b\u00ean h\u1ed1 ch\u1eadu,<\/p>\n

+ R\u1ea5t di \u0111\u1ed9ng.<\/p>\n

– Kh\u1ed1i u ph\u1ea7n ph\u1ee5:<\/p>\n

+ Kh\u1ed1i u n\u1eb1m \u1edf th\u1ea5p<\/p>\n

+ Th\u0103m \u00e2 m \u0111 \u1ea1 o th\u1ea5y \u0111\u01b0\u1ee3c kh\u1ed1i u<\/p>\n

+ R\u1ea5t di \u0111\u1ed9ng v\u00e0 m\u1ec1m
\n– Kh\u1ed1i u t\u1eed cung (u x\u01a1, k)<\/p>\n

+ N\u1eb1m \u1edf v\u00f9ng h\u1ea1 v\u1ecb.<\/p>\n

+ Th\u0103m \u00e2 m \u0111 \u1ea1 o th\u1ea5y u li\u1ec1n v\u1edbi t\u1eed cung.<\/p>\n

– Th\u1eadn sa.<\/p>\n

C\u00e2u 44: Tr\u00ecnh b\u00e0y c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh \u0111\u00e1i m\u00e1u?<\/p>\n

1. B\u1eb1ng que nh\u00fang Dipstick:<\/p>\n

– Nguy\u00ean t\u1eafc: Ph\u00e1t hi\u1ec7n ho\u1ea1t t\u00ednh Peroxidase c\u1ee7a Hem trong h\u1ed3ng c\u1ea7u, trong Hb t\u1ef1 do ho\u1eb7c trong Myoglobin<\/p>\n

– Cho k\u1ebft qu\u1ea3 (+) khi trong n\u01b0\u1edbc ti\u1ec3u > 3HC\/1 vi tr\u01b0\u1eddng 40, ch\u1ea5t ch\u1ec9 th\u1ecb m\u00e0u chuy\u1ec3n qua m\u00e0u xanh l\u00e1 c\u00e2y, xanh da tr\u1eddi.<\/p>\n

+ Gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n: Nhanh ch\u00f3ng, \u0111\u1ecbnh t\u00ednh, r\u1ebb ti\u1ec1n.<\/p>\n

+ H\u1ea1n ch\u1ebf:<\/p>\n

(+) Gi\u1ea3: Ti\u1ec3u Hemoglobin, Myoglobin, n\u01b0\u1edbc ti\u1ec3u c\u00f3 ch\u1ee9a ch\u1ea5t oxy ho\u00e1.<\/p>\n

(-) Gi\u1ea3: N\u01b0\u1edbc ti\u1ec3u c\u00f3 nhi\u1ec1u vitamin C.<\/p>\n

2. C\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u:<\/p>\n

– Nguy\u00ean t\u1eafc: Ph\u00e1t hi\u1ec7n h\u1ed3ng c\u1ea7u qua:<\/p>\n

+ Soi k\u00ednh hi\u1ec3n vi th\u01b0\u1eddng.<\/p>\n

+ Soi k\u00ednh hi\u1ec3n vi quang h\u1ecdc.<\/p>\n

– Gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n:<\/p>\n

+ \u0110\u1ecbnh l\u01b0\u1ee3ng cho k\u1ebft qu\u1ea3 ch\u00ednh x\u00e1c, x\u00e9t nghi\u1ec7m \u0111\u1ec3 ki\u1ec3m ch\u1ee9ng c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1i m\u00e1u \u0111\u1ea1i th\u1ec3, ho\u1eb7c que nh\u00fang c\u00f3 k\u1ebft qu\u1ea3 (+)<\/p>\n

+ T\u00ecm \u0111\u01b0\u1ee3c tr\u1ee5 h\u1ed3ng c\u1ea7u.<\/p>\n

+ H\u00ecnh d\u1ea1ng h\u1ed3ng c\u1ea7u d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi quang h\u1ecdc c\u00f3 \u0111\u1ed9 ph\u00f3ng \u0111\u1ea1i l\u1edbn.<\/p>\n

3. C\u1eb7n Addis:<\/p>\n

– M\u1ee5c \u0111\u00edch: \u0110\u1ebfm s\u1ed1 HC, BC, tr\u1ee5 h\u00ecnh trong 1 ph\u00fat.<\/p>\n

– Ph\u01b0\u01a1ng ph\u00e1p: C\u00f3 th\u1ec3 l\u1ea5y n\u01b0\u1edbc ti\u1ec3u 3h, 6h, 9h, 12h.<\/p>\n

*. N\u1ebfu l\u1ea5y n\u01b0\u1edbc ti\u1ec3u 3h (Th\u01b0\u1eddng l\u1ea5y n\u01b0\u1edbc ti\u1ec3u 3h)<\/p>\n

+ 6h s\u00e1ng b\u1ec7nh nh\u00e2n \u0111i ti\u1ec3u h\u1ebft, ghi gi\u1edd, ph\u00fat sau khi ti\u1ec3u h\u1ebft.<\/p>\n

+ U\u1ed1ng 200ml n\u01b0\u1edbc s\u00f4i \u0111\u1ec3 ngu\u1ed9i, n\u1eb1m ngh\u1ec9.<\/p>\n

+ 9h ti\u1ec3u h\u1ebft v\u00e0o c\u1ed1c thu\u1ef7 tinh c\u00f3 v\u1ea1ch s\u1eb5n, ghi gi\u1edd.<\/p>\n

+ \u0110o th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u (ghi r\u00f5 V ml)<\/p>\n

+ T\u00ednh s\u1ed1 ph\u00fat v\u00e0 t\u00ednh th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u trong 1 ph\u00fat (Vml\/ph\u00fat). L\u1eafc \u0111\u1ec1u n\u01b0\u1edbc ti\u1ec3u trong c\u1ed1c, l\u1ea5y 10ml quay li t\u00e2m, h\u00fat b\u1ecf 9 ml ph\u1ea7n tr\u00ean, c\u00f2n 1ml c\u1eb7n l\u1eafc \u0111\u1ec1u, \u0111em l\u00ean bu\u1ed3ng \u0111\u1ebfm, \u0111\u1ebfm nh\u01b0 \u0111\u1ebfm m\u00e1u.<\/p>\n

– K\u1ebft qu\u1ea3 \u0111\u1ebfm \u0111\u01b0\u1ee3c \/10 \u00b4 Vml n\u01b0\u1edbc ti\u1ec3u\/1 ph\u00fat = S\u1ed1 HC, BC, tr\u1ee5\/1ph\u00fat.<\/p>\n

– B\u00ecnh th\u01b0\u1eddng: HC: 1000\/ 1 ph\u00fat, BC: 2000\/ lph\u00fat,1-3 tr\u1ee5 h\u00ecnh\/1 ph\u00fat.<\/p>\n

C\u00e2u 45: Nguy\u00ean nh\u00e2n \u0111\u00e1i m\u00e1u th\u01b0\u1eddng g\u1eb7p?<\/p>\n

Trong th\u1ef1c h\u00e0nh, \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n \u0111\u00e1im\u00e1u, chia \u0111\u00e1i m\u00e1u th\u00e0nh hai nh\u00f3m: \u0111\u00e1i m\u00e1u t\u1eeb c\u1ea7u th\u1eadn do t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn v\u00e0 \u0111\u00e1im\u00e1u kh\u00f4ng t\u1eeb c\u1ea7u th\u1eadn.<\/p>\n

1\/\u0110\u00e1i m\u00e1u t\u1eeb c\u1ea7u th\u1eadn:<\/p>\n

\u00b7 \u0110\u1eb7c t\u00ednh:<\/p>\n

– Th\u01b0\u1eddng g\u1eb7p ti\u1ec3u m\u00e1u vi th\u1ec3h\u01a1n \u0111\u1ea1i th\u1ec3 v\u00e0 kh\u00f4ng c\u00f3 m\u00e1u c\u1ee5c trong n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

– H\u1ed3ng c\u1ea7u b\u1ecb bi\u1ebfn d\u1ea1ng.<\/p>\n

– C\u00f3 th\u1ec3 c\u00f3 tr\u1ee5 h\u1ed3ng c\u1ea7u.<\/p>\n

– Th\u01b0\u1eddng k\u00e8m ti\u1ec3u \u0111\u1ea1m > 2g\/24h.<\/p>\n

\u00b7 Nguy\u00ean nh\u00e2n: B\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t ho\u1eb7c th\u1ee9 ph\u00e1t<\/p>\n

– Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p:<\/p>\n

T\u0103ng huy\u1ebft \u00e1p.<\/p>\n

Ph\u00f9, ti\u1ec3u \u00edt.<\/p>\n

\u0110\u00e1i m\u00e1u \u0111\u1ed9t ng\u1ed9t vi th\u1ec3 ho\u1eb7c \u0111\u1ea1i th\u1ec3.<\/p>\n

Protein ni\u1ec7u, HC ni\u1ec7u bi\u1ebfn d\u1ea1ng, c\u00f3 th\u1ec3 c\u00f3 tr\u1ee5 HC.<\/p>\n

Si\u00eau \u00e2m: K\u00edch th\u01b0\u1edbc hai th\u1eadn b\u00ecnh th\u01b0\u1eddng.<\/p>\n

Ti\u1ec1n s\u1eed: Kh\u00f4ng c\u00f3 b\u1ec7nh c\u1ea7u th\u1eadn.<\/p>\n

– Vi\u00eam c\u1ea7u th\u1eadn m\u1ea1n:<\/p>\n

T\u0103ng huy\u1ebft \u00e1p.<\/p>\n

Ph\u00f9, ti\u1ec3u \u00edt.<\/p>\n

Protein ni\u1ec7u, HC ni\u1ec7u c\u00f3 th\u1ec3 bi\u1ebfn d\u1ea1ng bi\u1ebfn d\u1ea1ng<\/p>\n

Ur\u00ea – Creatinin m\u00e1u c\u00f3 th\u1ec3 t\u0103ng.<\/p>\n

Si\u00eau \u00e2m: K\u00edch th\u01b0\u1edbc hai th\u1eadn c\u00f3 th\u1ec3 nh\u1ecf h\u01a1n b\u00ecnh th\u01b0\u1eddng.<\/p>\n

Ti\u1ec1n s\u1eed: B\u1ec7nh th\u1eadn (Ph\u00f9, t\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i m\u00e1u)<\/p>\n

2\/\u0110\u00e1i m\u00e1u kh\u00f4ng t\u1eeb c\u1ea7u th\u1eadn:<\/p>\n

\u00b7 \u0110\u1eb7c t\u00ednh:<\/p>\n

– C\u00f3 th\u1ec3 c\u00f3 c\u1ee5c m\u00e1u \u0111\u00f4ng trong n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

– H\u1ed3ng c\u1ea7u kh\u00f4ng bi\u1ebfn d\u1ea1ng, Kh\u00f4ng c\u00f3 tr\u1ee5 h\u1ed3ng c\u1ea7u.<\/p>\n

– Th\u01b0\u1eddng kh\u00f4ng c\u00f3 ti\u1ec3u \u0111\u1ea1m, n\u1ebfu c\u00f3 ch\u1ec9 \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9<\/p>\n

\u00b7 Nguy\u00ean nh\u00e2n:<\/p>\n

– Tr\u01b0\u1edbc th\u1eadn: C\u00e1c b\u1ec7nh v\u1ec1 m\u00e1u ho\u1eb7c do \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng \u0111\u00f4ng qu\u00e1 li\u1ec1u \u0111\u00e1ng k\u1ec3 (Warfarin)<\/p>\n

– T\u1ea1i th\u1eadn:<\/p>\n

\u00d8 S\u1ecfi th\u1eadn:<\/p>\n

C\u01a1n \u0111au qu\u1eb7n th\u1eadn, \u0111\u00e1i bu\u1ed1t, \u0111\u00e1i d\u1eaft, n\u01b0\u1edbc ti\u1ec3u \u0111\u1ecf.<\/p>\n

Ti\u1ec1n s\u1eed: C\u00f3 th\u1ec3 c\u00f3 c\u01a1n \u0111au qu\u1eb7n th\u1eadn, \u0111\u00e1i ra m\u00e1u, \u0111\u00e1i ra s\u1ecfi<\/p>\n

XN n\u01b0\u1edbc ti\u1ec3u c\u00f3 th\u1ec3 c\u00f3 h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u, vi khu\u1ea9n.<\/p>\n

XQ, si\u00eau \u00e2m: Ph\u00e1t hi\u1ec7n s\u1ecfi<\/p>\n

\u00d8 K th\u1eadn:<\/p>\n

Nguy\u00ean ph\u00e1t ho\u1eb7c th\u1ee9 ph\u00e1t.<\/p>\n

Th\u1eadn to, c\u1ee9ng, m\u1eb7t l\u1ed5n nh\u1ed5n.<\/p>\n

\u0110\u00e1i ra m\u00e1u t\u1ef1 nhi\u00ean.<\/p>\n

Th\u1eed n\u01b0\u1edbc ti\u1ec3u c\u00f3 nhi\u1ec1u h\u1ed3ng c\u1ea7u.<\/p>\n

Ch\u1ee5p UIV: Th\u1eadn to 1 b\u00ean, \u0111\u00e0i b\u1ec3 th\u1eadn bi\u1ebfn d\u1ea1ng, c\u1eaft c\u1ee5t<\/p>\n

Si\u00eau \u00e2m: Th\u1eadn to 1 b\u00ean, \u0111\u00e0i b\u1ec3 th\u1eadn b\u1ecb k\u00e9o d\u00e0i, c\u1eaft c\u1ee5t l\u1ec7ch h\u01b0\u1edbng.<\/p>\n

\u00d8 Vi\u00eam th\u1eadn b\u1ec3 th\u1eadn:<\/p>\n

H\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng.<\/p>\n

\u0110au: \u0110au v\u00f9ng h\u1ed1 l\u01b0ng 1 b\u00ean ho\u1eb7c 2 b\u00ean, c\u00f3 th\u1ec3 c\u00f3 c\u01a1n \u0111au qu\u1eb7n th\u1eadn.<\/p>\n

H\u1ed9i ch\u1ee9ng b\u00e0ng quang.<\/p>\n

Kh\u00e1m th\u1eadn- ni\u1ec7u qu\u1ea3n: C\u00f3 th\u1ec3 c\u00f3 d\u1ea5u hi\u1ec7u ch\u1ea1m th\u1eadn (+)<\/p>\n

\u0110i\u1ec3m \u0111au ni\u1ec7u qu\u1ea3n c\u00f3 th\u1ec3 (+).<\/p>\n

XN n\u01b0\u1edbc ti\u1ec3u: C\u00f3 HC, BC, vi khu\u1ea9n.<\/p>\n

Si\u00eau \u00e2m: C\u00f3 th\u1ec3 c\u00f3 s\u1ecfi \u0111\u01b0\u1eddng ni\u1ec7u, \u0111\u00e0i b\u1ec3 th\u1eadn gi\u00e3n.<\/p>\n

\u00d8 Lao th\u1eadn:<\/p>\n

H\u1ed9i ch\u1ee9ng b\u00e0ng quang (th\u01b0\u1eddng g\u1eb7p).<\/p>\n

Tam ch\u1ee9ng: \u0111\u00e1i nhi\u1ec1u l\u1ea7n, \u0111\u00e1i kh\u00f3, \u0111\u00e1i m\u00e1u.<\/p>\n

\u0110au h\u1ed1 l\u01b0ng 1 b\u00ean ho\u1eb7c 2 b\u00ean.<\/p>\n

Kh\u00e1m c\u00f3 th\u1ec3 th\u1ea5y th\u1eadn to v\u00e0 \u0111au.<\/p>\n

T\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n suy s\u1ee5p.<\/p>\n

XN n\u01b0\u1edbc ti\u1ec3u:<\/p>\n

Soi tr\u1ef1c ti\u1ebfp sau khi nhu\u1ed9m Ziehlstiel – Nelsen: tr\u1ef1c khu\u1ea9n lao (+)<\/p>\n

Nu\u00f4i c\u1ea5y m\u00f4i tr\u01b0\u1eddng Loewenstein: tr\u1ef1c khu\u1ea9n lao.<\/p>\n

XQ ph\u1ed5i, h\u1ec7 ti\u1ebft ni\u1ec7u:<\/p>\n

Xquang kh\u00f4ng chu\u1ea9n b\u1ecb: B\u00f3ng th\u1eadn to.<\/p>\n

Ch\u1ee5p UIV: \u0110\u00e0i th\u1eadn nham nh\u1edf, c\u1eaft c\u1ee5t ho\u1eb7c gi\u00e3n to do t\u1eafc ngh\u1ebdn.<\/p>\n

\u00d8 Th\u1eadn \u0111a nang:<\/p>\n

B\u1ec7nh di truy\u1ec1n th\u1ec3 tr\u1ed9i kh\u00f4ng li\u00ean quan \u0111\u1ebfn gi\u1edbi t\u00ednh. C\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c c\u00f3 m\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng sau:<\/p>\n

\u0110au ngang th\u1eaft l\u01b0ng.<\/p>\n

T\u0103ng huy\u1ebft \u00e1p.<\/p>\n

Nhi\u1ec5m khu\u1ea9n ti\u1ebft ni\u1ec7u.<\/p>\n

\u0110\u00e1i ra m\u00e1u (nguy\u00ean nh\u00e2n \u0111\u1ebfn kh\u00e1m) do v\u1ee1 nang th\u1eadn, s\u1ecfi th\u1eadn. Th\u1eadn \u0111a nang hay k\u00e8m theo s\u1ecfi Uric (12%)<\/p>\n

Ti\u1ec1n s\u1eed gia \u0111\u00ecnh: C\u00f3 nhi\u1ec1u ng\u01b0\u1eddi b\u1ecb th\u1eadn \u0111a nang.<\/p>\n

\u00d8 Ch\u1ea5n th\u01b0\u01a1ng th\u1eadn:<\/p>\n

\u0110\u00e1i m\u00e1u l\u00e0 tri\u1ec7u ch\u1ee9ng quan tr\u1ecdng g\u1eb7p 80% tr\u01b0\u1eddng h\u1ee3p<\/p>\n

Ti\u1ec1n s\u1eed: C\u00f3 ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n

– Sau th\u1eadn:<\/p>\n

\u00d8 S\u1ecfi ni\u1ec7u qu\u1ea3n:<\/p>\n

C\u00f3 c\u01a1n \u0111au qu\u1eb7n th\u1eadn, c\u00f3 th\u1ec3 c\u00f3 h\u1ed9i ch\u1ee9ng b\u00e0ng quang<\/p>\n

\u0110\u00e1i m\u00e1u \u0111\u1ea1i th\u1ec3 ho\u1eb7c \u0111\u00e1i m\u00e1u vi th\u1ec3.<\/p>\n

Kh\u00e1m c\u00f3 th\u1ec3 c\u00f3 th\u1eadn to do \u1ee9 n\u01b0\u1edbc, \u1ee9 m\u1ee7 b\u1ec3 th\u1eadn.<\/p>\n

XN n\u01b0\u1edbc ti\u1ec3u: Nhi\u1ec1u h\u1ed3ng c\u1ea7u.<\/p>\n

XQ, si\u00eau \u00e2m: S\u1ecfi ni\u1ec7u qu\u1ea3n<\/p>\n

\u00d8 S\u1ecfi b\u00e0ng quang:<\/p>\n

H\u1ed9i ch\u1ee9ng b\u00e0ng quang.<\/p>\n

\u0110\u00e1i m\u00e1u cu\u1ed1i b\u00e3i.<\/p>\n

Si\u00eau \u00e2m, Xquang: C\u00f3 s\u1ecfi<\/p>\n

K, vi\u00eam, ch\u1ea5n th\u01b0\u01a1ng b\u00e0ng quang<\/p>\n

Ni\u1ec7u \u0111\u1ea1o, TLT: S\u1ecfi, K, vi\u00eam, ch\u1ea5n th\u01b0\u01a1ng, ph\u00ec \u0111\u1ea1i TLT<\/p>\n

\u0110\u00e1i kh\u00f3, \u0111\u00e1i r\u1eaft, b\u00ed \u0111\u00e1i (S\u1ecfi, U TLT), \u0111\u00e1i m\u00e1u (\u0111\u1ea7u b\u00e3i).C\u00e2u 47: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a v\u00e0 c\u00e1c b\u01b0\u1edbc th\u0103m kh\u00e1m ph\u00f9?<\/p>\n

I. \u0110\u1ecbnh ngh\u0129a: Ph\u00f9 l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng \u1ee9 n\u01b0\u1edbc trong c\u00e1c t\u1ed5 ch\u1ee9c d\u01b0\u1edbi da ho\u1eb7c ph\u1ee7 t\u1ea1ng.<\/p>\n

S\u1ef1 \u1ee9 n\u01b0\u1edbc c\u00f3 th\u1ec3 g\u00e2y n\u00ean b\u1edfi nhi\u1ec1u c\u01a1 ch\u1ebf, cho n\u00ean ph\u00f9 l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a r\u1ea5t nhi\u1ec1u b\u1ec7nh. Ph\u00f9 to\u00e0n th\u00e2n: ngh\u0129a l\u00e0 ph\u00f9 c\u1ea3 m\u1eb7t, th\u00e2n, ch\u00e2n tay, v\u00e0 th\u01b0\u1eddng k\u00e8m theo TDMP, tr\u00e0n d\u1ecbch m\u00e0ng b\u1ee5ng…<\/p>\n

T\u00f9y thu\u1ed9c v\u00e0o c\u0103n nguy\u00ean v\u00e0 c\u01a1 ch\u1ebf c\u1ee7a n\u00f3. Ph\u00f9 c\u00f3 th\u1ec3 khu tr\u00fa ho\u1eb7c to\u00e0n th\u00e2n<\/p>\n

Ch\u1ea9n \u0111o\u00e1n ph\u00f9 r\u1ea5t d\u1ec5 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p r\u00f5, nh\u01b0ng c\u0169ng c\u00f3 khi r\u1ea5t kh\u00f3<\/p>\n

II. C\u00e1c b\u01b0\u1edbc kh\u00e1m ph\u00f9:<\/p>\n

1. Ph\u00e1t hi\u1ec7n ph\u00f9:<\/p>\n

– Trong tr\u01b0\u1eddng h\u1ee3p ph\u00f9 r\u00f5: vi\u1ec7c ph\u00e1t hi\u1ec7n ph\u00f9 th\u01b0\u1eddng d\u1ec5, s\u1ef1 \u1ee9 n\u01b0\u1edbc trong t\u1ed5 ch\u1ee9c d\u01b0\u1edbi da th\u01b0\u1eddng l\u00e0m cho:<\/p>\n

\u00fc Ng\u01b0\u1eddi ph\u00f9 c\u00f3 c\u1ea3m gi\u00e1c n\u1eb7ng n\u1ec1.<\/p>\n

\u00fc Nh\u1eefng v\u00f9ng b\u1ecb ph\u00f9 s\u01b0ng to, c\u0103ng m\u1ecdng l\u00e0m che l\u1ea5p nh\u1eefng ch\u1ed7 l\u1ed3i l\u00f5m b\u00ecnh th\u01b0\u1eddng (m\u1eaft c\u00e1, n\u1ebfp nh\u0103n, \u0111\u1ea7u x\u01b0\u01a1ng).<\/p>\n

\u00fc M\u00e0u da v\u00f9ng b\u1ecb ph\u00f9 nh\u1ea1t \u0111i. T\u00ecm “d\u1ea5u \u1ea5n ng\u00f3n tay”<\/p>\n

– Tr\u01b0\u1eddng h\u1ee3p ph\u00f9 k\u00edn \u0111\u00e1o:<\/p>\n

S\u1ef1 \u1ee9 n\u01b0\u1edbc ch\u01b0a nhi\u1ec1u \u0111\u1ec3 bi\u1ec3u hi\u1ec7n th\u00e0nh nh\u1eefng tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng r\u00f5 r\u1ec7t, nh\u01b0ng th\u01b0\u1eddng \u0111\u1ee7 \u0111\u1ec3 l\u00e0m thay \u0111\u1ed5i c\u00e2n n\u1eb7ng ng\u01b0\u1eddi b\u1ec7nh m\u1ed9t c\u00e1ch nhanh ch\u00f3ng. V\u00ec v\u1eady c\u1ea7n ph\u1ea3i c\u00e2n b\u1ec7nh nh\u00e2n h\u00e0ng ng\u00e0y: T\u0103ng l\u00ean t\u1eeb 1 – 2 kg tr\u1edf l\u00ean trong v\u00e0i ng\u00e0y ch\u1ec9 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch b\u1eb1ng hi\u1ec7n t\u01b0\u1ee3ng ph\u00f9.<\/p>\n

2. Nh\u1eadn \u0111\u1ecbnh t\u00ednh ch\u1ea5t c\u1ee7a ph\u00f9:<\/p>\n

– M\u1ee9c \u0111\u1ed9 ph\u00f9 nhi\u1ec1u hay \u00edt v\u00e0 ti\u1ebfn tri\u1ec3n nhanh hay ch\u1eadm, t\u1ed1t nh\u1ea5t n\u00ean theo d\u00f5i c\u00e2n n\u1eb7ng h\u00e0ng ng\u00e0y \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c v\u00e0 c\u1ee5 th\u1ec3.<\/p>\n

– V\u1ecb tr\u00ed ph\u00f9: Ph\u00f9 to\u00e0n th\u00e2n hay ph\u00f9 khu tr\u00fa m\u1ed9t v\u00f9ng v\u00e0 xu\u1ea5t hi\u1ec7n \u1edf \u0111\u00e2u \u0111\u1ea7u ti\u00ean?<\/p>\n

– \u1ea4n l\u00f5m hay kh\u00f4ng ?<\/p>\n

– S\u1ef1 li\u00ean quan \u0111\u1ebfn th\u1eddi gian (bu\u1ed5i s\u00e1ng khi m\u1edbi ng\u1ee7 d\u1eady hay v\u1ec1 chi\u1ec1u):<\/p>\n

Ph\u00f9 xu\u1ea5t hi\u1ec7n bu\u1ed5i s\u00e1ng th\u01b0\u1eddng g\u1eb7p trong ph\u00f9 th\u1eadn.<\/p>\n

Ph\u00f9 ch\u1ec9 xu\u1ea5t hi\u1ec7n v\u1ec1 chi\u1ec1u th\u01b0\u1eddng g\u1eb7p: ph\u00f9 do suy tim \u1edf th\u1eddi k\u1ef3 \u0111\u1ea7u.<\/p>\n

Ph\u00f9 xu\u1ea5t hi\u1ec7n sau khi \u0111\u1ee9ng l\u00e2u: Ph\u00f9 tim trong th\u1eddi k\u1ef3 \u0111\u1ea7u, ph\u00f9 TM<\/p>\n

– T\u00e1c d\u1ee5ng c\u1ee7a ch\u1ebf \u0111\u1ed9 \u0103n nh\u1ea1t: th\u01b0\u1eddng kh\u00e1 r\u00f5 r\u1ec7t trong ph\u00f9 do suy tim, x\u01a1 gan v\u00e0 nh\u1ea5t l\u00e0 ph\u00f9 do vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p.<\/p>\n

3. Ph\u00e1t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng k\u00e8m theo:<\/p>\n

a. Ph\u1ea3n \u00e1nh m\u1ee9c \u0111\u1ed9 \u1ee9 n\u01b0\u1edbc:<\/p>\n

– T\u00ecnh tr\u1ea1ng m\u00e0ng ph\u1ed5i, m\u00e0ng b\u1ee5ng: Th\u01b0\u1eddng c\u00f3 tr\u00e0n d\u1ecbch trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p ph\u00f9 to, m\u00e0u s\u1eafc d\u1ecbch c\u00f3 th\u1ec3 trong ho\u1eb7c h\u01a1i v\u00e0ng nh\u01b0ng bao gi\u1edd c\u0169ng ch\u1ec9 c\u00f3 \u00edt protein v\u00e0 Rivalta(-) v\u00ec l\u00e0 d\u1ecbch th\u1ea5m.<\/p>\n

– S\u1ed1 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u th\u1ea3i ti\u1ebft trong 24h: N\u00f3i chung t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ph\u00f9 (Tr\u1eeb ph\u00f9 do vi\u00eam t\u1eafc t\u0129nh m\u1ea1ch v\u00e0 b\u1ea1ch m\u1ea1ch) \u0111\u1ec1u l\u00e0m cho ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e1i \u00edt. M\u1ee9c \u0111\u1ed9 gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u th\u01b0\u1eddng t\u1ec9 l\u1ec7 v\u1edbi t\u00ecnh tr\u1ea1ng ph\u00f9: Ph\u00f9 c\u00e0ng nhi\u1ec1u ng\u01b0\u1eddi b\u1ec7nh \u0111i ti\u1ec3u c\u00e0ng \u00edt.<\/p>\n

b. Ch\u1ec9 \u0111i\u1ec3m choc\u1ea3n tr\u1edf c\u01a1 gi\u1edbi tr\u00ean h\u1ec7 tu\u1ea7n ho\u00e0n:<\/p>\n

– Tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7:<\/p>\n

\u1ede ng\u1ef1c: ch\u1ec9 \u0111i\u1ec3m cho m\u1ed9t c\u1ea3n tr\u1edf c\u01a1 gi\u1edbi \u1edf h\u1ec7 t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean, th\u01b0\u1eddng c\u00f3 trong h\u1ed9i ch\u1ee9ng trung th\u1ea5t.<\/p>\n

\u1ede h\u1ea1 s\u01b0\u1eddn ph\u1ea3i v\u00e0 th\u01b0\u1ee3ng v\u1ecb ch\u1ec9 \u0111i\u1ec3m cho m\u1ed9t c\u1ea3n tr\u1edf c\u01a1 gi\u1edbi tr\u00ean h\u1ec7 th\u1ed1ng c\u1eeda – ch\u1ee7 th\u01b0\u1eddng c\u00f3 trong ph\u00f9 x\u01a1 gan.<\/p>\n

\u1ede b\u1eb9n v\u00e0 h\u1ea1 v\u1ecb ch\u1ec9 \u0111i\u1ec3m cho m\u1ed9t c\u1ea3n tr\u1edf c\u01a1 gi\u1edbi \u1edf h\u1ec7 t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi th\u01b0\u1eddng g\u1eb7p trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eafc ho\u1eb7c ch\u00e8n \u00e9p t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi.<\/p>\n

– Xanh t\u00edm: \u1edf m\u00f4i, \u1edf m\u1eb7t, ch\u1ec9 \u0111i\u1ec3m cho m\u1ed9t c\u1ea3n tr\u1edf c\u01a1 gi\u1edbi \u1edf t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean ho\u1eb7c tu\u1ea7n ho\u00e0n l\u1edbn, ho\u1eb7c \u1edf c\u00e1c chi t\u01b0\u01a1ng \u1ee9ng v\u1edbi t\u0129nh m\u1ea1ch c\u00f3 b\u1ec7nh.<\/p>\n

– Gan to, m\u1ec1m, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, ph\u1ea3n h\u1ed3i gan t\u0129nh m\u1ea1ch c\u1ed5 d\u01b0\u01a1ng t\u00ednh ch\u1ec9 \u0111i\u1ec3m cho ph\u00f9 do suy tim.<\/p>\n

– Kh\u00f3 th\u1edf: Nhi\u1ec1u ho\u1eb7c \u00edt, th\u01b0\u1eddng c\u00f3 ph\u00f9 trong suy tim.<\/p>\n

c. Ch\u1ec9 \u0111i\u1ec3m cho m\u1ed9t vi\u00eam nhi\u1ec5m \u0111\u1ecba ph\u01b0\u01a1ng:<\/p>\n

– T\u00ecnh tr\u1ea1ng n\u00f3ng, \u0111\u1ecf, \u0111au \u1edf v\u00f9ng \u0111\u00f3.<\/p>\n

– C\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft t\u01b0\u01a1ng \u1ee9ng v\u1edbi v\u00f9ng \u0111\u00f3 s\u01b0ng v\u00e0 \u0111au.<\/p>\n

– Th\u01b0\u1eddng s\u1ed1t nhi\u1ec1u ho\u1eb7c \u00edt.<\/p>\n

C\u00e2u 48: N\u00eau ch\u1ea9n \u0111o\u00e1n ph\u00f9 v\u00e0 c\u00e1c c\u1eadn l\u00e2m s\u00e0ng c\u1ea7n thi\u1ebft trong ch\u1ea9n \u0111o\u00e1n ph\u00f9<\/p>\n

I. Ch\u1ea9n \u0111o\u00e1n ph\u00f9:<\/p>\n

1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh:<\/p>\n

Th\u01b0\u1eddng kh\u00f4ng kh\u00f3 trong tr\u01b0\u1eddng h\u1ee3p r\u00f5 v\u00e0 c\u1ea3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p k\u00edn \u0111\u00e1o c\u0103n c\u1ee9 v\u00e0o c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p \u0111\u00e3 n\u00eau tr\u00ean. Nh\u01b0ng v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n ph\u00f9 l\u00e0 t\u00ecm ra nguy\u00ean nh\u00e2n.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n:<\/p>\n

Ph\u00f9 to\u00e0n th\u00e2n:<\/p>\n

– C\u00e1c b\u1ec7nh th\u1eadn: Ph\u00f9 c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m chung c\u1ee7a ph\u00f9 th\u1eadn:<\/p>\n

\u00fc Bao gi\u1edd c\u0169ng xu\u1ea5t hi\u1ec7n \u0111\u1ea7u ti\u00ean \u1edf m\u00ed m\u1eaft, \u1edf m\u1eb7t, r\u1ed3i m\u1edbi \u0111\u1ebfn c\u00e1c n\u01a1i kh\u00e1c<\/p>\n

\u00fc Kh\u00f4ng li\u00ean quan \u0111\u1ebfn th\u1eddi gian trong ng\u00e0y ho\u1eb7c t\u01b0 th\u1ebf ng\u01b0\u1eddi b\u1ec7nh (tr\u1eeb m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh ph\u1ea3i n\u1eb1m l\u00e2u).<\/p>\n

\u00fc Ph\u00f9 tr\u1eafng, m\u1ec1m, \u1ea5n l\u00f5m.<\/p>\n

\u00fc Bao gi\u1edd n\u01b0\u1edbc ti\u1ec3u c\u0169ng c\u00f3 Protein nhi\u1ec1u ho\u1eb7c \u00edt tu\u1ef3 theo b\u1ec7nh th\u1eadn.<\/p>\n

Ngo\u00e0i nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m chung tr\u00ean, tu\u1ef3 theo m\u1ed7i b\u1ec7nh th\u1eadn s\u1ebd c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m kh\u00e1c nhau:<\/p>\n

+ Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p, m\u1ea1n:<\/p>\n

Ph\u00f9 nhi\u1ec1u ho\u1eb7c \u00edt.<\/p>\n

\u0102n nh\u1ea1t gi\u1ea3m ph\u00f9 r\u00f5 r\u1ec7t.<\/p>\n

Huy\u1ebft \u00e1p th\u01b0\u1eddng t\u0103ng<\/p>\n

N\u01b0\u1edbc ti\u1ec3u:<\/p>\n

Protein nhi\u1ec1u ho\u1eb7c \u00edt (Nh\u01b0ng kh\u00f4ng qu\u00e1 3,5g\/24h).<\/p>\n

H\u1ed3ng c\u1ea7u: \u0110\u00e1i m\u00e1u \u0111\u1ea1i th\u1ec3 ho\u1eb7c vi th\u1ec3 g\u1ea7n 100% tr\u01b0\u1eddng h\u1ee3p.<\/p>\n

Tr\u1ee5 ni\u1ec7u: Th\u01b0\u1eddng c\u00f3 tr\u1ee5 ni\u1ec7u v\u00e0 kh\u00f4ng c\u00f3 tr\u1ee5 trong.<\/p>\n

M\u00e1u: Ur\u00ea, Creatinin, Cholesteron, Protein. . .b\u00ecnh th\u01b0\u1eddng.<\/p>\n

Th\u0103m d\u00f2 ch\u1ee9c n\u0103ng th\u1eadn: b\u1ecb r\u1ed1i lo\u1ea1n.<\/p>\n

+ H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0:<\/p>\n

Ph\u00f9 nhi\u1ec1u, ph\u00f9 nhanh, ph\u00f9 to c\u00f3 th\u1ec3 k\u00e8m theo tr\u00e0n d\u1ecbch c\u00e1c m\u00e0ng, \u0103n nh\u1ea1t kh\u00f4ng gi\u1ea3m ph\u00f9.<\/p>\n

Huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng.<\/p>\n

N\u01b0\u1edbc ti\u1ec3u:<\/p>\n

Protein r\u1ea5t nhi\u1ec1u (> 3,5g\/24h)<\/p>\n

H\u1ed3ng c\u1ea7u ni\u1ec7u c\u00f3 ho\u1eb7c kh\u00f4ng<\/p>\n

Tr\u1ee5 ni\u1ec7u: th\u01b0\u1eddng c\u00f3 nhi\u1ec1u tr\u1ee5 trong.<\/p>\n

M\u00e1u:<\/p>\n

Protein gi\u1ea3m v\u00e0 gi\u1ea3m ch\u1ee7 y\u1ebfu l\u00e0 Albumin<\/p>\n

M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u0103ng Cholesterol m\u00e1u.<\/p>\n

Th\u0103m d\u00f2 ch\u1ee9c n\u0103ng th\u1eadn: b\u00ecnh th\u01b0\u1eddng.<\/p>\n

+ Suy dinh d\u01b0\u1ee1ng: (M\u1ed9t ch\u1ebf \u0111\u1ed9 \u0103n kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 trong th\u1eddi gian d\u00e0i)<\/p>\n

Ch\u1ee7 y\u1ebfu l\u00e0 ph\u00f9 hai chi d\u01b0\u1edbi nh\u01b0ng c\u0169ng c\u00f3 khi ph\u00f9 to\u00e0n th\u00e2n.<\/p>\n

Kh\u00f4ng li\u00ean quan \u0111\u1ebfn th\u1eddi gian trong ng\u00e0y v\u00e0 t\u01b0 th\u1ebf c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

Ph\u00f9 tr\u1eafng, m\u1ec1m, \u1ea5n l\u00f5m.<\/p>\n

Kh\u00f4ng bao gi\u1edd c\u00f3 Protein trong n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

+ Ph\u00f9 n\u1ed9i ti\u1ebft:<\/p>\n

Ph\u00f9 c\u00f3 th\u1ec3 \u1edf hai chi d\u01b0\u1edbi nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 ph\u00f9 to\u00e0n th\u00e2n nh\u01b0ng r\u1ea5t k\u00edn \u0111\u00e1o: Ng\u01b0\u1eddi b\u1ec7nh c\u1ea3m th\u1ea5y m\u1eb7t h\u01a1i n\u1eb7ng, ch\u00e2n h\u01a1i n\u1eb7ng v\u00e0 \u1ea5n h\u01a1i l\u00f5m (Ph\u1ea3i theo d\u00f5i c\u00e2n n\u1eb7ng m\u1edbi bi\u1ebft l\u00e0 ph\u00f9).<\/p>\n

Th\u01b0\u1eddng x\u1ea3y ra \u1edf ph\u1ee5 n\u1eef v\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn chu k\u1ef3 kinh nguy\u1ec7t.<\/p>\n

Ph\u00f9 khu tr\u00fa: Ph\u00f9 ng\u1ef1c \u201cph\u00f9 \u00e1o kho\u00e1c\u201d, ph\u00f9 hai chi d\u01b0\u1edbi, ph\u00f9 m\u1ed9t chi, ph\u00f9 d\u1ecb \u1ee9ng:<\/p>\n

– Ph\u00f9 ng\u1ef1c ph\u00f9 \u00e1o kho\u00e1c: do ch\u00e8n \u00e9p trung th\u1ea5t.<\/p>\n

– Ph\u00f9 hai chi d\u01b0\u1edbi:<\/p>\n

\u00fc Ph\u00f9 do suy tim ph\u1ea3i: Ph\u00f9 l\u00fac \u0111\u1ea7u \u00edt v\u00e0 k\u00edn \u0111\u00e1o, ch\u1ec9 c\u00f3 \u1edf m\u1eaft c\u00e1 ch\u00e2n, xu\u1ea5t hi\u1ec7n v\u1ec1 chi\u1ec1u v\u1ec1 sau ph\u00f9 s\u1ebd th\u01b0\u1eddng xuy\u00ean v\u00e0 r\u1ec7t. Ch\u1ebf \u0111\u1ed9 ngh\u1ec9 ng\u01a1i v\u00e0 ch\u1ebf \u0111\u1ed9 \u0103n nh\u1ea1t gi\u1ea3m ph\u00f9. Ph\u00f9 m\u1ec1m, \u1ea5n l\u00f5m. Bao gi\u1edd c\u0169ng k\u00e8m theo gan to, m\u1ec1m, \u1ea5n t\u1ee9c, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, t\u00edm m\u00f4i v\u00e0 c\u00e1c \u0111\u1ea7u chi, kh\u00f3 th\u1edf, tim to, nh\u1ecbp tim nhanh. \u0110o \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch r\u1ea5t cao.<\/p>\n

\u00fc Ph\u00f9 trong x\u01a1 gan:M\u1ee9c \u0111\u1ed9 nhi\u1ec1u ho\u1eb7c \u00edt, \u1ea5n l\u00f5m, \u0103n nh\u1ea1t c\u00f3 th\u1ec3 gi\u1ea3m ph\u00f9 c\u00f3 th\u1ec3 k\u00e8m theo c\u1ed5 tr\u01b0\u1edbng th\u1ea9m th\u1ea5u, tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 c\u1eeda -ch\u1ee7, Albumin m\u00e1u gi\u1ea3m. Ch\u1ee9c n\u0103ng gan b\u1ecb r\u1ed1i lo\u1ea1n, n\u00ean soi \u1ed5 b\u1ee5ng v\u00e0 sinh thi\u1ebft gan n\u1ebfu nghi ng\u1edd.<\/p>\n

\u00fc Ph\u00f9 do suy dinh d\u01b0\u1ee1ng: (\u0111\u00e3 n\u00f3i \u1edf tr\u00ean).<\/p>\n

\u00fc Ph\u00f9 Beriberi:<\/p>\n

Ph\u00f9 ch\u1ee7 y\u1ebfu \u1edf b\u1eafp ch\u00e2n, l\u00e0m b\u1eafp ch\u00e2n ng\u01b0\u1eddi b\u1ec7nh c\u0103ng to.<\/p>\n

C\u00f3 th\u1ec3 \u1ea5n l\u00f5m.<\/p>\n

Kh\u00f4ng li\u00ean quan \u0111\u1ebfn t\u01b0 th\u1ebf ng\u01b0\u1eddi b\u1ec7nh v\u00e0 th\u1eddi gian trong ng\u00e0y.<\/p>\n

Bao gi\u1edd c\u0169ng k\u00e8m theo r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c ch\u1ee7 quan (t\u00ea b\u00ec, ki\u1ebfn b\u00f2, chu\u1ed9t r\u00fat) v\u00e0 m\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n g\u1ed1i.<\/p>\n

\u00fc Ph\u00f9 thai ngh\u00e9n: \u1edf nh\u1eefng s\u1ea3n ph\u1ee5 trong nh\u1eefng th\u00e1ng cu\u1ed1i c\u1ee7a thai k\u1ef3.<\/p>\n

\u00fc Ph\u00f9 m\u1ed9t chi: Th\u00f4ng th\u01b0\u1eddng nh\u1ea5t l\u00e0 m\u1ed9t chi. C\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn hai tr\u01b0\u1eddng h\u1ee3p:<\/p>\n

+ Vi\u00eam t\u1eafc t\u0129nh m\u1ea1ch: Ph\u00f9 m\u1ec1m, \u1ea5n kh\u00f4ng l\u00f5m, tr\u1eafng nh\u01b0ng r\u1ea5t \u0111au, \u0111au t\u1ef1 ph\u00e1t l\u00e0m ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng d\u00e1m c\u1eed \u0111\u1ed9ng ch\u00e2n, \u0111au t\u0103ng l\u00ean khi s\u1edd n\u1eafn chi, nh\u1ea5t l\u00e0 \u1edf \u0111o\u1ea1n chi g\u1ea7n ch\u1ed7 vi\u00eam t\u1eafc. N\u1eb1m ngh\u1ec9 v\u00e0 nh\u1ea5t l\u00e0 g\u00e1c ch\u00e2n l\u00ean cao, s\u1ebd l\u00e0m gi\u1ea3m b\u1edbt ph\u00f9. Th\u01b0\u1eddng k\u00e8m theo s\u1ed1t v\u00e0 m\u1ea1ch nhanh nh\u01b0ng kh\u00f4ng t\u01b0\u01a1ng x\u1ee9ng v\u1edbi s\u1ed1t.<\/p>\n

+ Vi\u00eam m\u1ea1ch b\u1ea1ch huy\u1ebft: L\u00fac \u0111\u1ea7u c\u0169ng ph\u00f9 gi\u1ed1ng nh\u01b0 trong ph\u00f9 t\u0129nh m\u1ea1ch: Ph\u00f9 m\u1ec1m, \u1ea5n kh\u00f4ng l\u00f5m, tr\u1eafng v\u00e0 c\u0169ng r\u1ea5t \u0111au, dai d\u1eb3ng, h\u1ea1n ch\u1ebf l\u01b0u th\u00f4ng b\u1ea1ch m\u1ea1ch, l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 Protein trong d\u1ecbch m\u00f4 k\u1ebd. C\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft t\u01b0\u01a1ng \u1ee9ng v\u1edbi c\u00e1c b\u1ea1ch huy\u1ebft \u0111\u00f3 s\u01b0ng to v\u00e0 \u0111au. V\u1ec1 sau c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u00e3 \u1ed5n \u0111\u1ecbnh, c\u00e1c t\u1ed5 ch\u1ee9c d\u01b0\u1edbi da v\u00e0 da d\u00e0y v\u00e0 c\u1ee9ng, \u0111\u00e2y l\u00e0 \u201cPh\u00f9 ch\u00e2n voi\u201d di ch\u1ee9ng c\u1ee7a vi\u00eam b\u1ea1ch m\u1ea1ch, nguy\u00ean nh\u00e2n \u1edf n\u01b0\u1edbc ta l\u00e0 do giun ch\u1ec9<\/p>\n

\u00fc Ph\u00f9 do d\u1ecb \u1ee9ng: Th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t \u1edf xung quanh m\u1eaft, mi\u1ec7ng v\u00e0 th\u01b0\u1eddng m\u1ea5t \u0111i r\u1ea5t nhanh sau khi \u0111i\u1ec1u tr\u1ecb.<\/p>\n

II. c\u1eadn l\u00e2m s\u00e0ng c\u1ea7n thi\u1ebft<\/p>\n

\u00fc M\u00e1u :<\/p>\n

C\u00f4ng th\u1ee9c m\u00e1u, VS.<\/p>\n

\u0110\u1ecbnh l\u01b0\u1ee3ng Protein, \u0111i\u1ec7n di Protein m\u00e1u.<\/p>\n

Cholesterol, \u0111\u01b0\u1eddng m\u00e1u, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, ur\u00ea, creatinin m\u00e1u.<\/p>\n

\u00fc N\u01b0\u1edbc ti\u1ec3u:<\/p>\n

Th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

\u0110\u1ecbnh l\u01b0\u1ee3ng Protein ni\u1ec7u, soi c\u1eb7n t\u00ecm HC, BC, vi khu\u1ea9n, c\u00e1c tr\u1ee5 ni\u1ec7u.<\/p>\n

Ur\u00ea ni\u1ec7u. . .<\/p>\n

\u00fc Si\u00eau \u00e2m.<\/p>\n

\u00fc Xquang.<\/p>\n

\u00fc \u0110i\u1ec7n gi\u1ea3i \u0111\u1ed3.<\/p>\n

\u00fc \u0110o \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung t\u00e2m\u2026<\/p>\n

C\u00e2u 50 : Tr\u00ecnh b\u00e0y nguy\u00ean nh\u00e2n, tr.ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng c\u1ee7a h\u1ed9i ch\u1ee9ng c\u01b0\u1eddng gi\u00e1p ?<\/p>\n

I. Nguy\u00ean nh\u00e2n: B\u1ec7nh t\u1ef1 mi\u1ec5n v\u1edbi xu\u1ea5t hi\u1ec7n kh\u00e1ng th\u1ec3 trong m\u00e1u. Ng\u00e0y nay,ng\u01b0\u1eddi ta \u0111\u00e3 ph\u00e1t hi\u1ec7n trong m\u00e1u b\u1ec7nh nh\u00e2n Basedow hai kh\u00e1ng th\u1ec3 tham giav\u00e0o c\u01a1 ch\u1ebf b\u1ec7nh sinh<\/p>\n

– LATS: (+) 40 – 60%. Kh\u00e1ng th\u1ec3 n\u00e0y g\u1eafn v\u00e0o kh\u00e1ng nguy\u00ean m\u00e0ng t\u1ebf b\u00e0o gi\u00e1p v\u00e0k\u00edch th\u00edch t\u1ebf b\u00e0o tuy\u1ebfn gi\u00e1p ho\u1ea1t \u0111\u1ed9ng, ti\u1ebft T3, T4.<\/p>\n

– TSI: (+) 80 – 90%. Kh\u00e1ng th\u1ec3 n\u00e0y \u1ee9c ch\u1ebf TSH g\u1eafn v\u00e0o th\u1ee5 th\u1ec3 TSH v\u00e0 ch\u00ednh b\u1ea3nth\u00e2n n\u00f3 g\u1eafn v\u00e0o th\u1ee5 th\u1ec3 TSH v\u00e0 k\u00edch th\u00edch t\u1ebf b\u00e0o tuy\u1ebfn gi\u00e1p ho\u1ea1t \u0111\u1ed9ng, ti\u1ebft T3, T4.<\/p>\n

* Y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i<\/p>\n

– Tu\u1ed5i: 20 \u2013 50 tu\u1ed5i.<\/p>\n

– Gi\u1edbi: N\u1eef, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi mang thai.<\/p>\n

– Di truy\u1ec1n.<\/p>\n

– Stress.<\/p>\n

– Nhi\u1ec5m virus, vi khu\u1ea9n.<\/p>\n

– Thu\u1ed1c ch\u1ee9a nhi\u1ec1u Iode: Cordarone.<\/p>\n

II. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/p>\n

1. H\u1ed9i ch\u1ee9ng c\u01b0\u1eddng gi\u00e1p:<\/p>\n

– G\u1ea7y s\u00fat c\u00e2n.<\/p>\n

– Da \u1ea9m, ra m\u1ed3 h\u00f4i nhi\u1ec1u; s\u1ee3 n\u00f3ng, th\u00edch l\u1ea1nh.<\/p>\n

– Tim m\u1ea1ch:<\/p>\n

+Nh\u1ecbp tim nhanh, c\u00f3 th\u1ec3 rung nh\u0129 ho\u1eb7c cu\u1ed3ng nh\u0129.<\/p>\n

+ Huy\u1ebft \u00e1p t\u00e2m thu t\u0103ng, huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng gi\u1ea3m, huy\u1ebft \u00e1p trung b\u00ecnhkh\u00f4ng thay \u0111\u1ed5i.<\/p>\n

+ Suy tim v\u1edbi giai \u0111o\u1ea1n \u0111\u1ea7u l\u00e0 cung l\u01b0\u1ee3ng cao, giai \u0111o\u1ea1n sau l\u00e0 cung l\u01b0\u1ee3ng th\u1ea5p.<\/p>\n

– Th\u1ea7n kinh:<\/p>\n

+K\u00edch th\u00edch g\u00e2y kh\u00f3 ng\u1ee7, c\u00e1u g\u1eaft ho\u1eb7c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n.<\/p>\n

+Run tay hai b\u00ean v\u1edbi t\u1ea7n s\u1ed1 nhanh, bi\u00ean \u0111\u1ed9 nh\u1ecf.<\/p>\n

– C\u01a1: Y\u1ebfu v\u00e0 teo c\u01a1 g\u1ed1c chi.<\/p>\n

– Tri\u1ec7u ch\u1ee9ng kh\u00e1c: Ti\u00eau ch\u1ea3y, r\u1ed1i lo\u1ea1n kinh nguy\u1ec7t.<\/p>\n

2. B\u01b0\u1edbu gi\u00e1p: Hay g\u1eb7p xu\u1ea5t hi\u1ec7n b\u01b0\u1edbu gi\u00e1p v\u1edbi \u0111\u1eb7c \u0111i\u1ec3m<\/p>\n

– L\u1edbn (hay g\u1eb7p \u0111\u1ed9 I, II), lan t\u1ecfa, th\u00f9y (P) > th\u00f9y (T).<\/p>\n

– M\u1eadt \u0111\u1ed9 m\u1ec1m, h\u01a1i c\u0103ng, \u0111\u00e0n h\u1ed3i, kh\u00f4ng \u0111au, da v\u00f9ng tuy\u1ebfn gi\u00e1p b\u00ecnh th\u01b0\u1eddng.<\/p>\n

– B\u01b0\u1edbu m\u1ea1ch:S\u1edd th\u1ea5y rung miu.Nghe ti\u1ebfng th\u1ed5i t\u00e2m thu ho\u1eb7c li\u00ean t\u1ee5c,r\u00f5 nh\u1ea5tv\u00f9ng c\u1ef1c tr\u00ean tuy\u1ebfn gi\u00e1p.<\/p>\n

3. Bi\u1ec3u hi\u1ec7n t\u1ea1i m\u1eaft<\/p>\n

– C\u01a1 n\u0103ng<\/p>\n

+ Ch\u00f3i m\u1eaft.<\/p>\n

+ Ch\u1ea3y n\u01b0\u1edbc m\u1eaft.<\/p>\n

+ C\u1ed9m nh\u01b0 b\u1ee5i v\u00e0o m\u1eaft, n\u00f3ng r\u00e1t.<\/p>\n

– Th\u1ef1c th\u1ec3<\/p>\n

+ M\u1eaft nh\u00ecn ch\u1eb1m ch\u1eb1m, \u00edt ch\u1edbp, \u00e1nh m\u1eaft long lanh<\/p>\n

+ Co c\u01a1 n\u00e2ng mi tr\u00ean (C\u01a1 muller)<\/p>\n

\u00b7 D\u1ea5u hi\u1ec7u Dalrymple: H\u1edf khe mi.<\/p>\n

\u00b7 D\u1ea5u hi\u1ec7u Stellwag Khe mi r\u1ed9ng.<\/p>\n

\u00b7 D\u1ea5u hi\u1ec7u Joeffroy: M\u1ea5t ph\u1ed1i h\u1ee3p gi\u1eefa c\u01a1 tr\u00e1n v\u00e0 n\u00e2ng mi tr\u00ean.<\/p>\n

\u00b7 D\u1ea5u hi\u1ec7u Von Graefe: M\u1ea5t \u0111\u1ed3ng v\u1eadn gi\u1eefa nh\u00e3n c\u1ea7u v\u00e0 mi tr\u00ean khi nh\u00ecn xu\u1ed1ng.<\/p>\n

+ T\u1ea9m nhu\u1eadn \u1edf m\u00f4 chung quanh h\u1ed1c m\u1eaft<\/p>\n

\u00b7 Ph\u00f9 n\u1ec1 mi m\u1eaft (mi tr\u00ean).<\/p>\n

\u00b7 Vi\u1ec1n s\u1eadm m\u00e0u quanh mi m\u1eaft: D\u1ea5u hi\u1ec7u Jellinek.<\/p>\n

+ L\u1ed3i m\u1eaft th\u1eadt s\u1ef1<\/p>\n

\u00b7 L\u1ed3i c\u1ea3 hai b\u00ean.<\/p>\n

\u00b7 Nhi\u1ec1u ho\u1eb7c \u00edt.<\/p>\n

\u00b7 \u0110\u1ec1u ho\u1eb7c kh\u00f4ng \u0111\u1ec1u.<\/p>\n

+ Li\u1ec7t c\u01a1 v\u1eadn nh\u00e3n<\/p>\n

\u00b7 D\u1ea5u hi\u1ec7u Moebius.<\/p>\n

\u00b7 M\u1eaft c\u00f3 th\u1ec3 kh\u00f4ng nh\u00ecn l\u00ean, xu\u1ed1ng, li\u1ebfc ngang\u2026<\/p>\n

+ Bi\u1ec3u hi\u1ec7n n\u1eb7ng n\u1ec1<\/p>\n

\u00b7 Ph\u00f9, sung huy\u1ebft, lo\u00e9t gi\u00e1c m\u1ea1c ho\u1eb7c k\u1ebft m\u1ea1c.<\/p>\n

\u00b7 M\u00f9 m\u1eaft: T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh th\u1ecb gi\u00e1c.<\/p>\n

\u00b7 D\u1ea5u hi\u1ec7u ngo\u1ea1i bi\u00ean<\/p>\n

– Ph\u00f9 ni\u00eam: 2 \u2013 3%, hi\u1ebfm g\u1eb7p \u1edf Vi\u1ec7t Nam.<\/p>\n

+ Hay g\u1eb7p tr\u01b0\u1edbc x\u01b0\u01a1ng ch\u00e0y, \u0111\u1ed1i x\u1ee9ng hai b\u00ean, kh\u00f4ng bao gi\u1edd qu\u00e1 \u0111\u1ea7u g\u1ed1i.<\/p>\n

+ M\u00e0u n\u00e2u, h\u1ed3ng ho\u1eb7c \u0111\u1ecf t\u00edm, c\u00e1c l\u1ed7 ch\u00e2n l\u00f4ng gi\u00e3n, d\u1ea1ng v\u1ecf cam.<\/p>\n

+ D\u00e0y, ph\u00f9 c\u1ee9ng, \u1ea5n kh\u00f4ng l\u00f5m.<\/p>\n

– Ng\u00f3n tay ch\u00e2n<\/p>\n

+ H\u00ecnh d\u00f9i tr\u1ed1ng (D\u00e0y m\u00e0ng x\u01b0\u01a1ng).<\/p>\n

+ D\u1ea5u ch\u1ee9ng ti\u00eau m\u00f3ng tay.<\/p>\n

III. Tri\u1ec7u ch\u1ee9ng c\u1eadn l\u00e2m s\u00e0ng<\/p>\n

1. H\u1ed9i ch\u1ee9ng c\u01b0\u1eddng gi\u00e1p ngo\u1ea1i bi\u00ean<\/p>\n

– N\u1ed9i ti\u1ebft t\u1ed1<\/p>\n

+ T3, FT3, T4, FT4 t\u0103ng.<\/p>\n

+ TSH gi\u1ea3m nhi\u1ec1u ho\u1eb7c = 0.<\/p>\n

– \u1ea2nh h\u01b0\u1edfng T3, T4 t\u1ea1i ngo\u1ea1i bi\u00ean<\/p>\n

+ Chuy\u1ec3n h\u00f3a c\u01a1 b\u1ea3n t\u0103ng.<\/p>\n

+ Glucose m\u00e1u t\u0103ng.<\/p>\n

+ Cholesterol m\u00e1u gi\u1ea3m.<\/p>\n

2. T\u1ea1i tuy\u1ebfn gi\u00e1p<\/p>\n

– Si\u00eau \u00e2m tuy\u1ebfn gi\u00e1p<\/p>\n

+ T\u0103ng th\u1ec3 t\u00edch tuy\u1ebfn gi\u00e1p.<\/p>\n

+ T\u0103ng l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn m\u00f4 gi\u00e1p.<\/p>\n

+ T\u0103ng v\u1eadn t\u1ed1c m\u00e1u \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch gi\u00e1p.<\/p>\n

– \u0110\u1ed9 t\u1eadp trung Iode ph\u00f3ng x\u1ea1 t\u1ea1i tuy\u1ebfn gi\u00e1p<\/p>\n

+ Cho b\u1ec7nh nh\u00e2n u\u1ed1ng li\u1ec1u nh\u1ecf I131 ph\u00f3ng x\u1ea1 (10 \u00b5ci).<\/p>\n

+ \u0110o \u0111\u1ed9 t\u1eadp trung I131 \u1edf gi\u1edd th\u1ee9 2, 6, 24 t\u1ea1i tuy\u1ebfn gi\u00e1p \u0111\u01b0\u1ee3c bao nhi\u00eau so v\u1edbi<\/p>\n

l\u01b0\u1ee3ng I131 u\u1ed1ng v\u00e0o.<\/p>\n

+ K\u1ebft qu\u1ea3: N\u1ebfu Basedow bi\u1ec3u hi\u1ec7n g\u00f3c tho\u00e1t, t\u0103ng cao.<\/p>\n

– Nghi\u1ec7m ph\u00e1p \u1ee9c ch\u1ebf Werner: \u00c1p d\u1ee5ng cho b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9 t\u1eadp trung Iode cao<\/p>\n

+ Cho u\u1ed1ng 100 \u00b5g T3 x 7 ng\u00e0y r\u1ed3i \u0111o l\u1ea1i \u0111\u1ed9 t\u1eadp trung 24h l\u1ea7n 2.<\/p>\n

+ T\u00ednh ch\u1ec9 s\u1ed1 h\u00e3m (CSH): CSH = (F1 – F2)\/F1<\/p>\n

+ CSH < 20%: Basedow<\/p>\n

+ CSH = 40 – 80% : H\u00e1o Iode<\/p>\n

– Nghi\u1ec7m ph\u00e1p k\u00edch th\u00edch Querido<\/p>\n

+ T\u01b0\u01a1ng t\u1ef1 nh\u01b0 nghi\u1ec7m ph\u00e1p Werner.<\/p>\n

+ Ti\u00eam TSH 10UI\/ ng\u00e0y x 3 \u2013 6 ng\u00e0y r\u1ed3i \u0111o \u0111\u1ed9 t\u1eadp trung Iode l\u1ea7n 2 \u1edf 24 gi\u1edd sau.<\/p>\n

+ K\u1ebft qu\u1ea3: N\u1ebfu l\u1ea7n 2 t\u0103ng < 20% l\u00e0 b\u1ec7nh l\u00fd Basedow. – X\u1ea1 h\u00ecnh tuy\u1ebfn gi\u00e1p + Cho b\u1ec7nh nh\u00e2n u\u1ed1ng I131, sau \u0111\u00f3 d\u00f9ng m\u00e1y CT scanner ho\u1eb7c\u03b3 camera ghih\u00ecnh tuy\u1ebfn gi\u00e1p. + Basedow: Tuy\u1ebfn gi\u00e1p t\u0103ng th\u1ec3 t\u00edch v\u00e0 t\u0103ng b\u1eaft \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1 (H\u00ecnh \u0111\u1eadmv\u00e0 \u0111\u1ed3ng \u0111\u1ec1u). 3. X\u00e9t nghi\u1ec7m kh\u00e1ng th\u1ec3 – Kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 TSH (TRAb): (+) 80 – 90% – Kh\u00e1ng th\u1ec3 kh\u00e1ng Thyroglobulin (TgAb) : (+) 20 – 40% – Kh\u00e1ng th\u1ec3 kh\u00e1ng Peroxydase (TPOAb) : Cho bi\u1ebft s\u1ef1 hi\u1ec7n di\u1ec7n b\u1ec7nh t\u1ef1 mi\u1ec5n. C\u00e2u 51: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m l\u00e2m s\u00e0ng to\u00e0n th\u00e2n: c\u00e2n n\u1eb7ng chi\u1ec1u cao, da l\u00f4ng t\u00f3c trong kh\u00e1m b\u1ec7nh h\u1ec7 n\u1ed9i ti\u1ebft ? \u0110a s\u1ed1 c\u00e1c b\u1ec7nh n\u1ed9i ti\u1ebft \u0111\u1ec1u c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u00ecnh d\u1ea1ng chung c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. C\u1ea7n ch\u00fa \u00fd c\u00e1c \u0111i\u1ec3m sau: v Nh\u00ecn chung \u0111\u1ec3 bi\u1ebft: – T\u01b0 th\u1ebf l\u00fac ngh\u1ec9 ng\u01a1i – H\u00ecnh d\u1ea1ng m\u1eb7t, th\u00e2n, c\u00e1c chi – M\u00e0u s\u1eafc v\u00e0 t\u00ednh ch\u1ea5t c\u1ee7a da Nhi\u1ec1u khi nh\u00ecn \u0111\u00e3 gi\u00fap ta ngh\u0129 \u0111\u1ebfn b\u1ec7nh n\u00e0o \u0111\u00f3 c\u1ee7a tuy\u1ebfn n\u1ed9i ti\u1ebft nh\u01b0 thay \u0111\u1ed5i m\u1eb7t (n\u00e9t m\u1eb7t \u0111\u1eb7c bi\u1ec7t c\u1ee7a b\u1ec7nh to c\u00e1c vi\u1ec5n c\u1ef1c, tr\u00e1n v\u1ed3, da kh\u00f3e mi\u1ec7ng d\u00e0y v\u00e0 x\u1ebfp n\u1ebfp, \u1ed5 m\u1eaft to ra, c\u1eb1m b\u1ea1nh…), m\u1eaft l\u1ed3i trong b\u1ec7nh basedow. v Chi\u1ec1u cao: – D\u00f9ng th\u01b0\u1edbc \u0111o chi\u1ec1u cao c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, \u0111\u00e1nh gi\u00e1 chi\u1ec1u cao so v\u1edbi tu\u1ed5i t\u01b0\u01a1ng \u1ee9ng \u0111\u1ec3 bi\u1ebft cao qu\u00e1 hay l\u00f9n qu\u00e1 so v\u1edbi b\u00ecnh th\u01b0\u1eddng, nh\u1ea5t l\u00e0 \u0111\u1ed1i v\u1edbi tr\u1ebb em v\u00e0 nh\u1eefng ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i. – \u0110\u1ed3ng th\u1eddi ph\u1ea3i \u0111o c\u00e1c x\u01b0\u01a1ng d\u00e0i (c\u1eb3ng tay, c\u00e1nh tay, c\u1eb3ng ch\u00e2n, \u0111\u00f9i), \u0111o v\u00f2ng \u0111\u1ea7u xem c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng \u1ee9 n\u01b0\u1edbc n\u00e3o hay \u0111\u1ea7u qu\u00e1 nh\u1ecf, \u0111o v\u00f2ng ng\u1ef1c\u2026 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 c\u00e2n \u0111\u1ed1i gi\u1eefa c\u00e1c b\u1ed9 ph\u1eadn. – Vi\u1ec7c c\u00e2n \u0111o n\u00e0y r\u1ea5t c\u1ea7n thi\u1ebft, nh\u1ea5t l\u00e0 \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh ch\u01b0a \u0111\u1ebfn tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh. v C\u00e2n n\u1eb7ng – Theo d\u00f5i c\u00e2n n\u1eb7ng ng\u01b0\u1eddi b\u1ec7nh, h\u1ecfi k\u1ef9 xem s\u1ef1 thay \u0111\u1ed5i c\u00e2n n\u1eb7ng qua c\u00e1c giai \u0111o\u1ea1n c\u1ee7a b\u1ec7nh, th\u1eddi gian xu\u1ea5t hi\u1ec7n v\u00e0 c\u00e1c \u0111i\u1ec1u ki\u1ec7n xu\u1ea5t hi\u1ec7n c\u1ee7a g\u1ea7y ho\u1eb7c b\u00e9o. – G\u1ea7y: c\u00f3 th\u1ec3 g\u1ea7y t\u1ef1 nhi\u00ean, \u1edf \u0111\u00e2y l\u1edbp c\u01a1 ph\u00e1t tri\u1ec3n c\u00e2n \u0111\u1ed1i, nh\u01b0ng l\u1edbp m\u1ee1 \u01b0\u1edbi da th\u00ec kh\u00f4ng c\u00f3. Tr\u00e1i v\u1edbi g\u1ea7y b\u1ec7nh l\u00fd, l\u1edbp c\u01a1 v\u00e0 m\u1ee1 \u0111\u1ec1u r\u1ea5t k\u00e9m ph\u00e1t tri\u1ec3n. Trong b\u1ec7nh Simmonds, ng\u01b0\u1eddi b\u1ec7nh g\u1ea7y ho\u00e0n to\u00e0n. B\u1ec7nh th\u01b0\u1eddng g\u1eb7p nhu basedow, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng tuyp 1. – B\u00e9o: C\u00f3 th\u1ec3 b\u00e9o to\u00e0n th\u00e2n hay khu tr\u00fa m\u1ed9t s\u1ed1 b\u1ed9 ph\u1eadn m\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 m\u00f4ng, \u0111\u00f9i, m\u1eb7t, b\u1ee5ng v\u00e0 ng\u1ef1c. Nh\u01b0 b\u00e9o m\u1eb7t, th\u00e2n trong b\u1ec7nh ph\u00ec sinh d\u1ee5c. Trong h\u1ed9i ch\u1ee9ng cushing b\u00e9o t\u1eadp trung \u1edf m\u1eb7t, th\u00e2n c\u00f2n t\u1ee9 chi l\u1ea1i teo (tr\u1eeb g\u1ed1c chi) v Da, l\u00f4ng, t\u00f3c, m\u00f3ng. – Da: + Xem thay \u0111\u1ed5i v\u1ec1 m\u00e0u s\u1eafc, s\u1ef1 xu\u1ea5t hi\u1ec7n c\u00e1c m\u1ea3ng s\u1eafc t\u1ed1\u2026 ch\u00fa \u00fd kh\u00e1m nh\u1eefng ch\u1ed5 da \u0111\u1eb7c bi\u1ec7t nh\u01b0 c\u00f9i tay, c\u00e1c n\u1ebfp c\u1ed5, l\u00f2ng b\u00e0n tay, b\u1eb9n. + Nhi\u1ec7t \u0111\u1ed9 c\u1ee7a da nh\u01b0 n\u00f3ng, ra m\u1ed3 h\u00f4i nhi\u1ec1u, trong b\u1ec7nh b\u1ec7nh Basedow. v\u00e0 ng\u01b0\u1ee3c l\u1ea1i suy gi\u00e1p tr\u1ea1ng da l\u00fac n\u00e0o c\u0169ng kh\u00f4, r\u00f5 nh\u1ea5t l\u00e0 \u1edf b\u00e0n tay, b\u00e0n ch\u00e2n + Xem ni\u00eam m\u1ea1c m\u00f4i, m\u00e1, l\u1ee3i: s\u1ea1m ni\u00eam m\u1ea1c c\u00f9ng s\u1ea1m da th\u01b0\u1eddng g\u1eb7p trong b\u1ec7nh addison – L\u00f4ng t\u00f3c m\u00f3ng: + T\u00f3c, l\u00f4ng mi, l\u00f4ng m\u00e0y kh\u00f4 v\u00e0 d\u1ec5 g\u00e3y trong suy gi\u00e1p tr\u1ea1ng, th\u01b0a th\u1edbt trong suy sinh d\u1ee5c, r\u1ee5ng trong b\u1ec7nh Simmonds. C\u00e1c tri\u1ec7u ch\u1ee9ng tr\u00ean k\u1ebft h\u1ee3p v\u1edbi da xanh thi\u1ebfu m\u00e1u g\u1eb7p trong h\u1ed9i ch\u1ee9ng Sheehan. C\u00f3 khi r\u1eadm l\u00f4ng nhi\u1ec1u, \u0111\u1ed3ng th\u1eddi m\u1ecdc nhi\u1ec1u m\u1ee5c tr\u1ee9ng c\u00e1 hay g\u1eb7p trong h\u1ed9i ch\u1ee9ng apert gallais. + R\u00e2u, m\u1ecdc r\u00e2u \u1edf n\u1eef trong b\u1ec7nh Cushing + Nam kh\u00f4ng c\u00f3 r\u00e2u trong b\u1ec7nh suy sinh d\u1ee5c. + M\u00f3ng d\u1ec5 g\u1eaby trong suy gi\u00e1p. + R\u0103ng m\u1ecdc k\u00e9m, s\u00e2u trong suy c\u00e2n gi\u00e1p tr\u1ea1ng. D\u1ec5 g\u00e3y, c\u00f3 m\u1ee7 l\u1ee3i, d\u1ec5 r\u1ee5ng trong \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. R\u0103ng m\u1ecdc th\u01b0a trong b\u1ec7nh to \u0111\u1ea7u chi. C\u00e2u 52: tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m c\u00e1c b\u1ed9 ph\u1eadn: tuy\u1ebfn gi\u00e1p, tu\u1ea7n ho\u00e0n, ti\u00eau h\u00f3a v\u00e0 ghi nh\u1eadn m\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng b\u1ec7nh l\u00fd trong th\u0103m kh\u00e1m b\u1ec7nh h\u1ec7 n\u1ed9i ti\u1ebft. v Tuy\u1ebfn gi\u00e1p – Nh\u00ecn: + B\u00ecnh th\u01b0\u1eddng kh\u00f4ng nh\u00ecn th\u1ea5y tuy\u1ebfn gi\u00e1p. Nh\u01b0ng khi tuy\u1ebfn to l\u00ean c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y v\u00e0 khi ng\u01b0\u1eddi b\u1ec7nh nu\u1ed1t c\u00f3 th\u1ec3 th\u1ea5y di \u0111\u1ed9ng theo nh\u1ecbp nu\u1ed1t. + Nh\u00ecn c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 s\u01a1 b\u1ed9 v\u1ec1 h\u00ecnh th\u1ec3, k\u00edch th\u01b0\u1edbc, lo\u1ea1i to to\u00e0n b\u1ed9 hay m\u1ed9t ph\u1ea7n – S\u1edd v\u00e0 \u0111o tuy\u1ebfn gi\u00e1p: + Ng\u01b0\u1eddi b\u1ec7nh ng\u1ed3i, t\u01b0 th\u1ebf tho\u1ea3i m\u00e1i, \u1edf n\u01a1i \u0111\u1ee7 \u00e1nh s\u00e1ng. \u0110\u1ea7u h\u01a1i nghi\u00eang ra tr\u01b0\u1edbc \u0111\u1ec3 l\u00e0m ch\u00f9ng c\u01a1 ph\u00eda tr\u01b0\u1edbc gi\u00e1p tr\u1ea1ng. H\u01a1i n\u00e2ng c\u1eb1m \u0111\u1ec3 m\u1edf r\u1ed9ng v\u00f9ng gi\u00e1p tr\u1ea1ng cho d\u1ec5 s\u1edd. Ng\u00f3n tr\u1ecf v\u00e0 ng\u00f3n c\u00e1i \u0111\u00e8 v\u00e0o gi\u1eefa thanh qu\u1ea3n v\u00e0 c\u01a1 \u1ee9c \u0111\u00f2n ch\u0169m, sau \u0111\u00f3 b\u1ea3o ng\u01b0\u1eddi b\u1ec7nh nu\u1ed1t, s\u1ebd th\u1ea5y tuy\u1ebfn di \u0111\u1ed9ng theo nh\u1ecbp nu\u1ed1t Khi s\u1edd c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh: \u00b7 Th\u1ec3 t\u00edch v\u00e0 gi\u1edbi h\u1ea1n c\u1ee7a tuy\u1ebfn. \u00b7 M\u1eadt \u0111\u1ed9 tuy\u1ebfn c\u1ee9ng hay m\u1ec1m. \u00b7 M\u1eb7t tuy\u1ebfn nh\u1eb5n hay g\u1ed3 gh\u1ec1 \u00b7 Tuy\u1ebfn to to\u00e0n b\u1ed9, m\u1ed9t ph\u1ea7n hay nhi\u1ec1u nh\u00e2n. \u00b7 N\u1ebfu l\u00e0 m\u1ed9t b\u01b0\u1edbu m\u1ea1ch khi s\u1edd c\u00f3 th\u1ec3 th\u1ea5y rung miu t\u00e2m thu hay li\u00ean t\u1ee5c.(r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n basedow) + \u0110\u1ec3 theo d\u00f5i s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a tuy\u1ebfn, ng\u01b0\u1eddi ta th\u01b0\u1eddng \u0111o tuy\u1ebfn gi\u00e1p tr\u1ea1ng. D\u00f9ng m\u1ed9t th\u01b0\u1edbc d\u00e2y \u0111o v\u00f2ng qua ch\u1ed7 to nh\u1ea5t c\u1ee7a tuy\u1ebfn, ta \u0111o kho\u1ea3ng n\u1eeda th\u00e1ng ho\u1eb7c m\u1ed9t th\u00e1ng \u0111o l\u1ea1i m\u1ed9t l\u1ea7n \u0111\u1ec3 bi\u1ebft tuy\u1ebfn to hay nh\u1ecf \u0111i m\u1ed9t c\u00e1ch ch\u00ednh x\u00e1c. – Nghe Ch\u1ec9 trong tr\u01b0\u1eddng h\u1ee3p b\u01b0\u1edbu m\u1ea1ch, nghe m\u1edbi c\u00f3 th\u1ec3 th\u1ea5y ti\u1ebfng th\u1ed5i t\u00e2m thu hay ti\u1ebfng th\u1ed5i li\u00ean t\u1ee5c. Ti\u1ebfng th\u1ed5i nghe th\u1ea5y r\u00f5 \u1edf thu\u1ef3 tr\u00ean ph\u1ea3i v\u00e0 tr\u00e1i, l\u00e0 n\u01a1i m\u1ea1ch m\u00e1u to \u0111i v\u00e0o tuy\u1ebfn. Khi n\u1eb1m ti\u1ebfng th\u1ed5i nghe r\u00f5 h\u01a1n khi ng\u1ed3i v B\u1ed9 m\u00e1y tu\u1ea7n ho\u00e0n Trong c\u00e1c r\u1ed1i lo\u1ea1n c\u1ee7a b\u1ed9 m\u00e1y tu\u1ea7n ho\u00e0n c\u1ea7n ch\u00fa \u00fd: – Huy\u1ebft \u00e1p: + T\u0103ng huy\u1ebft \u00e1p: C\u00f3 th\u1ec3 th\u1ea5y t\u0103ng huy\u1ebft \u00e1p do c\u01b0\u1eddng tu\u1ef7 v\u00e0 v\u1ecf th\u01b0\u1ee3ng th\u1eadn, b\u1ec7nh Basedow. + H\u1ea1 huy\u1ebft \u00e1p: C\u00f3 th\u1ec3 th\u1ea5y trong b\u1ec7nh Addison, suy gi\u00e1p tr\u1ea1ng. v Tim:Th\u01b0\u1eddng \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u01a1 tim v\u00e0 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. + Nh\u1ecbp tim nhanh trong b\u1ec7nh Basedow. + Nh\u1ecbp tim ch\u1eadm trong suy gi\u00e1p tr\u1ea1ng v\u00e0 suy tuy\u1ebfn y\u00ean. + C\u00f3 th\u1ec3 th\u1ea5y r\u1ed1i lo\u1ea1n nh\u1ecbp tim, suy tim trong b\u1ec7nh Basedow (bi\u1ebfn ch\u1ee9ng) + \u0110\u1ed9ng m\u1ea1ch v\u00e0nh b\u1ecb vi\u00eam, x\u01a1 trong b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. + Tim to hay tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim trong b\u1ec7nh ph\u00f9 ni\u00eam (myxoedem) v B\u1ed9 m\u00e1y ti\u00eau ho\u00e1.Kh\u1ea9u v\u1ecb: + Ch\u00e1n \u0103n trong b\u1ec7nh Simmonds, sheehan + \u0102n u\u1ed1ng qu\u00e1 nhi\u1ec1u trong b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. + C\u00e1c r\u1ed1i lo\u1ea1n do ph\u1ea3n \u1ee9ng c\u1ee7a th\u1ea7n kinh th\u1ef1c v\u1eadt d\u1ea1 d\u00e0y. + Ti\u00eau ho\u00e1 k\u00e9m, t\u00e1o b\u00f3n trong b\u1ec7nh ph\u00f9 ni\u00eam. + \u1ec8a ch\u1ea3y trong b\u1ec7nh Basedow. + \u0110au b\u1ee5ng, n\u00f4n m\u1eeda trong h\u1ea1 canxi m\u00e1u. * Ph\u00e2n \u0111\u1ed9 tuy\u1ebfn gi\u00e1p theo t\u1ed5 ch\u1ee9c y t\u1ebf th\u1ebf gi\u1edbi: \u0110\u1ed9 0: kh\u00f4ng th\u1ea5y b\u01b0\u1edbu gi\u00e1p khi nh\u00ecn v\u00e0 s\u1edd \u0110\u1ed9 I: s\u1edd th\u1ea5y b\u01b0\u1edbu gi\u00e1p > 1 ng\u00f3n tay c\u00e1i<\/p>\n

IA: kh\u00f4ng nh\u00ecn th\u1ea5y \u1edf m\u1ecdi t\u01b0 th\u1ebf<\/p>\n

IB: ch\u1ec9 nh\u00ecn th\u1ea5y b\u01b0\u1edbu khi ng\u1eeda c\u1ed5<\/p>\n

\u0110\u1ed9 II: b\u01b0\u1edbu to nh\u00ecn th\u1ea5y khi \u0111\u1ea7u \u1edf t\u01b0 th\u1ebf b\u00ecnh th\u01b0\u1eddng ho\u1eb7c \u1edf g\u1ea7n<\/p>\n

\u0110\u1ed9 III: b\u01b0\u1edbu r\u1ea5t to, nh\u00ecn th\u1ea5y d\u00f9 r\u1ea5t xa, l\u00e0m bi\u1ebfn d\u1ea1ng c\u1ed5 b\u1ec7nh nh\u00e2n.C\u00e2u 53:Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng suy gi\u00e1p.<\/p>\n

a. Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:<\/p>\n

– C\u00e1c tri\u1ec7u ch\u1ee9ng do gi\u1ea3m chuy\u1ec3n h\u00f3a:<\/p>\n

+ Suy nh\u01b0\u1ee3c to\u00e0n th\u1ec3 : ch\u1eadm ch\u1ea1p,th\u1edd \u01a1 ngo\u1ea1i c\u1ea3nh, kh\u1ea3 n\u0103ng t\u1eadp trung k\u00e9m, hay bu\u1ed3n ng\u1ee7 ng\u1ee7 g\u00e0, b\/n nam hay c\u00f3 li\u1ec7t d\u01b0\u01a1ng, n\u1eef r\u1ed1i lo\u1ea1n kinh nguy\u1ec7t<\/p>\n

+ T\u0103ng c\u00e2n nhi\u1ec1u v\u00e0 nhanh<\/p>\n

+ Th\u00e2n nhi\u1ec7t th\u1ea5p, s\u1ee3 l\u1ea1nh<\/p>\n

+ T\u00e1o b\u00f3n, nh\u1ecbp tim ch\u1eadm<\/p>\n

– Thay \u0111\u1ed5i da, ni\u00eam m\u1ea1c, l\u00f4ng t\u00f3c m\u00f3ng<\/p>\n

+ Da xanh, c\u00f3 m\u00e0u v\u00e0ng nh\u1ea1t nh\u01b0 s\u00e1p, kh\u00f4, l\u1ea1nh kh\u00f4ng c\u00f3 m\u1ed3 h\u00f4i<\/p>\n

+ T\u00edm nh\u1eb9 \u1edf hai g\u00f2 m\u00e1 v\u00e0 m\u00f4i<\/p>\n

+ T\u00f3c, l\u00f4ng: kh\u00f4 c\u1ee9ng, r\u1ee5ng nhi\u1ec1u<\/p>\n

+ M\u00f3ng kh\u00f4, c\u00f3 kh\u00eda, d\u1ec5 g\u1eaby<\/p>\n

+ Th\u00e2m nhi\u1ec5m da.<\/p>\n

+ M\u1eb7t ph\u00ec ra, c\u00e1nh m\u0169i to b\u00e8, m\u00f4i d\u1ea7y, m\u1eb7t m\u1ea5t c\u00e1c n\u1ebfp nh\u0103n t\u1ea1o ra v\u1ebb m\u1eb7t v\u00f4 c\u1ea3m<\/p>\n

+ Ng\u00f3n tay, ng\u00f3n ch\u00e2n to ra, da c\u1eb3ng ch\u00e2n c\u0103ng bong, \u1ea5n \u00edt l\u00f5m<\/p>\n

+ Tr\u00e0n d\u1ecbch c\u00e1c m\u00e0ng<\/p>\n

+ Th\u00e2m nhi\u1ec5m ni\u00eam m\u1ea1c: \u1edf d\u00e2y thanh \u00e2m v\u00e0 thanh qu\u1ea3n l\u00e0m gi\u1ecdng tr\u1edf n\u00ean tr\u1ea7m, \u1edf v\u00f2i eustache l\u00e0m gi\u1ea3m th\u00ednh l\u1ef1c v\u00e0 \u00fa tai, \u1edf m\u0169i l\u00e0m g\u00e1y to khi ng\u1ee7, \u1edf l\u01b0\u1ee1i l\u00e0m l\u01b0\u1ee1i to<\/p>\n

– Tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh c\u01a1:<\/p>\n

+ C\u01a1 l\u1ef1c gi\u1ea3m, s\u1edd c\u01a1 th\u1ea5y c\u1ea3m gi\u00e1c c\u0103ng c\u1ee9ng, b\/n hay b\u1ecb chu\u1ed9t r\u00fat, d\u1ecb c\u1ea3m \u1edf \u0111\u1ea7u chi<\/p>\n

+ Kh\u00e1m ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng th\u1ea5y co c\u01a1 ch\u1eadp<\/p>\n

– Tim m\u1ea1ch:nh\u1ecbp tim ch\u1eadm, ti\u1ebfng tim m\u1edd, kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, tim c\u00f3 th\u1ec3 to ho\u1eb7c c\u00f3 th\u1ec3 c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim<\/p>\n

– Kh\u00e1m tuy\u1ebfn gi\u00e1p: bi\u1ec3u hi\u1ec7n t\u00f9y nguy\u00ean nh\u00e2n<\/p>\n

+ Th\u00f4ng th\u01b0\u1eddng kh\u00f4ng s\u1edd th\u1ea5y tuy\u1ebfn gi\u00e1p<\/p>\n

+ \u0110\u00f4i khi c\u00f3 th\u1ec3 th\u1ea5y b\u01b0\u1edbu gi\u00e1p, n\u1ebfu s\u1ea9y ra \u1edf ph\u1ee5 n\u1eef tr\u00ean 40 tu\u1ed5i<\/p>\n

b. C\u1eadn l\u00e2m s\u00e0ng:<\/p>\n

– C\u00e1c xn \u0111\u00e1nh gi\u00e1 \u1ea3nh h\u01b0\u1edfng ngo\u1ea1i bi\u00ean c\u1ee7a s\u1ef1 gi\u1ea3m hormone tuy\u1ebfn gi\u00e1p<\/p>\n

+ C\u00f4ng th\u1ee9c m\u00e1u: HC gi\u1ea3m v\u1eeba, th\u01b0\u1eddng thi\u1ebfu m\u00e1u \u0111\u1eb3ng s\u1eafc<\/p>\n

+ \u0110i\u1ec7n gi\u1ea3i \u0111\u1ed3: Na th\u01b0\u1eddng gi\u1ea3m<\/p>\n

+ Cholesteron, triglycerit t\u0103ng<\/p>\n

+ Th\u1eddi gian ph\u1ea3n x\u1ea1 \u0111\u1ed3 g\u00e2n g\u00f3t k\u00e9o d\u00e0i 0,30 gi\u00e2y<\/p>\n

+ Chuy\u1ec3n h\u00f3a c\u01a1 b\u1ea3n gi\u1ea3m<\/p>\n

– \u0110\u1ecbnh l\u01b0\u1ee3ng hormone<\/p>\n

+ T3,T4, to\u00e0n ph\u1ea7n v\u00e0 t\u1ef1 do gi\u1ea3m<\/p>\n

+ TSH t\u0103ng cao (nguy\u00ean nh\u00e2n t\u1ea1i tuy\u1ebfn gi\u00e1p).TSH gi\u1ea3m (nguy\u00ean nh\u00e2n t\u1ea1i v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i<\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c:<\/p>\n

+ \u0110i\u1ec7n tim: nh\u1ecbp tim ch\u1eadm, \u0111i\u1ec7n th\u1ebf th\u1ea5p, s\u00f3ng T d\u1eb9t<\/p>\n

+ Men CPK t\u0103ng do t\u1ed5n th\u01b0\u01a1ng c\u01a1.<\/p>\n

C\u00e2u 54: Ph\u00e2n lo\u1ea1i v\u00e0ng da?<\/p>\n

1. Ph\u00e2n lo\u1ea1i theo nguy\u00ean nh\u00e2n<\/p>\n

a. V\u00e0ng da do tan m\u00e1u: C\u00f2n g\u1ecdi l\u00e0 v\u00e0ng da tr\u01b0\u1edbc gan, do s\u1ef1 ph\u00e1 h\u1ee7y qu\u00e1 m\u1ee9c h\u1ed3ng c\u1ea7u \u1edf t\u1ed5 ch\u1ee9c li\u00ean v\u00f5ng n\u1ed9i m\u00f4 g\u00e2y t\u0103ng bilirubin t\u1ef1 do trong m\u00e1u.<\/p>\n

– B\u1ea9m sinh: b\u1ec7nh huy\u1ebft s\u1eafc t\u1ed1 nh\u01b0 Thalasimie<\/p>\n

– M\u1eafc ph\u1ea3i: b\u1ea5t \u0111\u1ed3ng nh\u00f3m m\u00e1u do truy\u1ec1n m\u00e1u, tan m\u00e1u do s\u1ed1t r\u00e9t \u0111\u00e1i huy\u1ebft s\u1eafc t\u1ed1<\/p>\n

b. V\u00e0ng da do \u1ee9 m\u1eadt<\/p>\n

– \u1ee8 m\u1eadt trong gan nh\u01b0 vi\u00eam gan si\u00eau vi, vi\u00eam gan m\u1ea1n, vi\u00eam gan nhi\u1ec5m \u0111\u1ed9c do thu\u1ed1c, x\u01a1 gan \u1ee9 m\u1eadt ti\u00ean ph\u00e1t, vi\u00eam x\u01a1 \u0111\u01b0\u1eddng m\u1eadt nh\u1ecf<\/p>\n

– \u1ee8 m\u1eadt ngo\u00e0i gan: nh\u01b0 K gan,s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7, u t\u1ee5y, vi\u00eam c\u01a1 oddi<\/p>\n

2. Ph\u00e2n lo\u1ea1i theo c\u01a1 ch\u1ebf chuy\u1ec3n h\u00f3a Bilirubin<\/p>\n

-T\u0103ng Bilirubint\u1ef1 do chi\u1ebfm \u01b0u th\u1ebf do:<\/p>\n

s\u1ea3n xu\u1ea5t Bilirubin t\u0103ng qu\u00e1 m\u1ee9c chuy\u1ec3n h\u00f3a c\u1ee7a gan<\/p>\n

do gi\u1ea3m thu nh\u1eadn Bilirubin t\u1ea1i t\u1ebf b\u00e0o gan.<\/p>\n

do gi\u1ea3m li\u00ean h\u1ee3p Bilirubin t\u1ea1i t\u1ebf b\u00e0o gan.<\/p>\n

-T\u0103ng Bilirubin li\u00ean h\u1ee3p chi\u1ebfm \u01b0u th\u1ebf do gi\u1ea3m b\u00e0i xu\u1ea5t Bilirubin t\u1eeb t\u1ebf b\u00e0o gan v\u00e0o \u1ed1ng m\u1eadt v\u00e0 t\u1eeb \u1ed1ng m\u1eadt xu\u1ed1ng ru\u1ed9t, n\u00ean tr\u00e0o ng\u01b0\u1ee3c m\u00e1u.<\/p>\n

-T\u0103ng Bilirubin h\u1ed7n h\u1ee3p (c\u1ea3 t\u1ef1 do v\u00e0 li\u00ean h\u1ee3p) do:<\/p>\n

do gi\u1ea3m thu nh\u1eadn Bilirubin t\u1ea1i t\u1ebf b\u00e0o gan.<\/p>\n

do gi\u1ea3m li\u00ean h\u1ee3p Bilirubin t\u1ea1i t\u1ebf b\u00e0o gan.<\/p>\n

do gi\u1ea3m b\u00e0i xu\u1ea5t Bilirubin c\u1ee7a t\u1ebf b\u00e0o gan<\/p>\n

3. Ph\u00e2n lo\u1ea1i theo v\u1ecb tr\u00ed g\u00e2y v\u00e0ng da:<\/p>\n

-V\u00e0ng da tru\u1edbc gan.<\/p>\n

-V\u00e0ng da trong gan.<\/p>\n

-V\u00e0ng da sau gan.<\/p>\n

C\u00e2u 55: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n

1. H\u1ecfi b\u1ec7nh<\/p>\n

– H\u1ecfi xem c\u00e2n n\u1eb7ng c\u1ee7a BN g\u1ea7n \u0111\u00e2y c\u00f3 gi\u1ea3m s\u00fat nhi\u1ec1u hay kh\u00f4ng? C\u1ee5 th\u1ec3 gi\u1ea3m m\u1ea5y kg trong m\u1ea5y th\u00e1ng g\u1ea7n \u0111\u00e2y? C\u00f3 c\u1ea3m gi\u00e1c m\u1ec7t m\u1ecfi ho\u1eb7c m\u1ea5t s\u1ee9c kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c kh\u00f4ng?<\/p>\n

– H\u1ecfi xem BN c\u00f3 c\u1ea3m gi\u00e1c kh\u00e1t n\u01b0\u1edbc? Ng\u00e0y u\u1ed1ng bao nhi\u00eau n\u01b0\u1edbc? C\u00f3 c\u1ea3m gi\u00e1c kh\u00f4 m\u00f4i, kh\u00f4 mi\u1ec7ng? \u0110o s\u1ed1 l\u01b0\u1ee3ng n\u01b0\u1edbc u\u1ed1ng m\u1ed7i ng\u00e0y.<\/p>\n

– H\u1ecfi BN c\u00f3 ti\u1ec3u nhi\u1ec1u kh\u00f4ng? S\u1ed1 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u\/24h? Trong 1 \u0111\u00eam \u0111i ti\u1ec3u m\u1ea5y l\u1ea7n? S\u1ed1 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u m\u1ed7i l\u1ea7n \u0111i? \u0110o l\u01b0\u1eddng s\u1ed1 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u m\u1ed7i ng\u00e0y<\/p>\n

– H\u1ecfi BN c\u00f3 \u0103n nhi\u1ec1u? B\u1eefa \u0103n m\u1ea5y ch\u00e9n c\u01a1m, ng\u00e0y \u0103n m\u1ea5y l\u1ea7n?<\/p>\n

– Ngo\u1ea3i a c\u00f2n c\u00f3 1 s\u1ed1 tri\u1ec7u ch\u1ee9ng kh\u00e1c nh\u01b0: nh\u00ecn m\u1edd, r\u1ed1i lo\u1ea1n t \u00ec n h d \u1ee5 c \u1edf nam, t\u00ea ho\u1eb7c d\u1ecb c\u1ea3m \u0111\u1ea7u chi, d\u1ec5 nhi\u1ec5m tr\u00f9ng v\u00e0 hay t\u00e1i ph\u00e1t.<\/p>\n

2. Kh\u00e1m b\u1ec7nh<\/p>\n

– \u0110o c\u00e2n n\u1eb7ng, chi\u1ec1u cao, v\u00f2ng eo, v\u00f2ng m\u00f4ng c\u1ee7a BN. T\u00ednh ch\u1ec9 s\u1ed1 BMI<\/p>\n

– \u0110o huy\u1ebft \u00e1p, t\u00ecm d\u1ea5u hi\u1ec7u gi\u1eadt d\u00e2y chu\u00f4ng \u1edf \u0110M khu\u1ef7u tay, s\u1edd m\u1ea1ch m\u00e1u th\u00e1i d\u01b0\u01a1ng t\u00ecm d\u1ea5u hi\u1ec7u d\u00e2y th\u1eebng, s\u1edd c\u00e1c \u0110M ch\u00e0y tr\u01b0\u1edbc, ch\u00e0y sau, \u0110M quay… t\u00ecm d\u1ea5u hi\u1ec7u x\u01a1 c\u1ee9ng, m\u1ea1ch y\u1ebfu.<\/p>\n

– B\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u l\u1edbn: c\u00e1c t\u1ed5n th\u01b0\u01a1ng x\u01a1 v\u1eefa c\u00e1c m\u1ea1ch m\u00e1u l\u1edbn v\u00e0 v\u1eeba, g\u1eb7p s\u1edbm v\u00e0 nhi\u1ec1u \u1edf BN \u0110T\u0110 nh\u01b0 suy m\u1ea1ch v\u00e0nh, h\u1eb9p ho\u1eb7c vi\u00eam t\u1eafc \u0110M chi d\u01b0\u1edbi, tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o tho\u00e1ng qua ho\u1eb7c nh\u0169n n\u00e3o, xu\u1ea5t huy\u1ebft n\u00e3o.<\/p>\n

– Cao huy\u1ebft \u00e1p: r\u1ea5t hay g\u1eb7p \u1edf BN \u0110T\u0110 tr\u00ean 40 tu\u1ed5i, c\u01a1 ch\u1ebf ch\u01b0a r\u00f5<\/p>\n

– B\u1ec7nh l\u00ed vi m\u1ea1ch: c\u00e1c t\u1ed5n th\u01b0\u01a1ng mao m\u1ea1ch \u0111\u1eb7c tr\u01b0ng l\u00e0 d\u00e0y \u0111\u00e1y mao m\u1ea1ch kh\u1eafp c\u01a1 th\u1ec3, quan tr\u1ecdng nh\u1ea5t l\u00e0 \u1edf \u0111\u00e1y m\u1eaft g\u00e2y nh\u00ecn m\u1edd, c\u00f3 th\u1ec3 m\u00f9 l\u00f2a v\u00e0 c\u1ea7u th\u1eadn<\/p>\n

\u00d8 L\u01b0u \u00fd: N\u00ean ngh\u0129 \u0111\u1ebfn v\u00e0 c\u1ea7n x\u00e9t nghi\u1ec7m x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n \u0110T\u0110 khi BN c\u00f3 c\u00e1c b\u1ec7nh c\u1ea3nh LS:<\/p>\n

+ H\u1ed9i ch\u1ee9ng 4 nhi\u1ec1u (\u0103n nhi\u1ec1u, u\u1ed1ng nhi\u1ec1u, ti\u1ec3u nhi\u1ec1u, s\u1ee5t c\u00e2n nhi\u1ec1u)<\/p>\n

+ B\u00e9o ph\u00ec (ch\u1ec9 s\u1ed1 kh\u1ed1i, ch\u1ec9 s\u1ed1 eo\/m\u00f4ng)<\/p>\n

+ Nhi\u1ec5m khu\u1ea9n hay t\u00e1i ph\u00e1t<\/p>\n

+ M\u1ed9t s\u1ed1 b\u1ec7nh tim m\u1ea1ch (vi\u00eam t\u1eafc \u0110M, nh\u1ed3i m\u00e1u c\u01a1 tim, t\u0103ng huy\u1ebft \u00e1p)<\/p>\n

+ Ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi thu\u1ed9c tr\u1ef1c h\u1ec7 b\u1ecb \u0110T\u0110<\/p>\n

+ Ph\u1ee5 n\u1eef c\u00f3 ti\u1ec1n s\u1eed \u0111\u1ebb con tr\u00ean 4kg, ho\u1eb7c thai ch\u1ebft trong t\u1eed cung<\/p>\n

+ X\u00e9t nghi\u1ec7m trong c\u00e1c b\u1ec7nh c\u1ea5p t\u00ednh m\u00e0 c\u00f3 \u0111\u01b0\u1eddng m\u00e1u cao l\u00fac \u0111\u00f3i, ho\u1eb7c \u0111\u01b0\u1eddng ni\u1ec7u (+), ho\u1eb7c t\u0103ng triglycerid m\u00e1u.<\/p>\n

3. Kh\u00e1m t\u00ecm c\u00e1c b\u1ec7nh c\u00f3 th\u1ec3 g\u00e2y t\u0103ng \u0111\u01b0\u1eddng m\u00e1u<\/p>\n

– B\u1ec7nh tuy\u1ebft t\u1ee5y: vi\u00eam t\u1ee5y m\u1ea1n, s\u1ecfi t\u1ee5y, K t\u1ee5y<\/p>\n

– B\u1ec7nh n\u1ed9i ti\u1ebft: h.ch\u1ee9ng cushing, acromegalie, basedow, u t\u1ee7y th\u01b0\u1ee3ng th\u1eadn<\/p>\n

– Do d\u00f9ng thu\u1ed1c k\u00e9o d\u00e0i nh\u01b0 corticoid, l\u1ee3i ti\u1ec3u thiazide, hormone tuy\u1ebfn gi\u00e1p<\/p>\n

– M\u1ed9t s\u1ed1 h\u1ed9i ch\u1ee9ng di truy\u1ec1n c\u1ee7a n\u00f3 nh\u01b0: Down, Klinefelter, Turner, Wolfram.<\/p>\n

4. Kh\u00e1m t\u00ecm bi\u1ebfn ch\u1ee9ng c\u1ee7a ti\u1ec3u \u0111\u01b0\u1eddng<\/p>\n

– H\u1ecfi xem c\u00f3 tri\u1ec7u ch\u1ee9ng nhi\u1ec5m tr\u00f9ng nh\u01b0 ti\u1ec3u l\u00e1u, ti\u1ec3u bu\u1ed1t?<\/p>\n

– H\u1ecfi xem c\u00f3 d\u1ea5u hi\u1ec7u \u0111au ng\u1ef1c? C\u00f3 d\u1ea5u hi\u1ec7u thi\u1ec3u n\u0103ng v\u00e0nh?<\/p>\n

– H\u1ecfi c\u1ea3m gi\u00e1c t\u00ea b\u00ec, nh\u1ee9c m\u1ecfi \u1edf ch\u00e2n<\/p>\n

– Kh\u00e1m r\u0103ng: xem r\u0103ng c\u00f3 lung lay<\/p>\n

– \u0110o th\u1ecb l\u1ef1c, n\u1ebfu m\u1eaft m\u1edd c\u1ea7n soi \u0111\u00e1y m\u1eaft<\/p>\n

– Kh\u00e1m b\u00e0n ch\u00e2n xem c\u00f3 ch\u1ed7 n\u00e0o \u0111au, m\u1ea5t c\u1ea3m gi\u00e1c? Lo\u00e9t gan b\u00e0n ch\u00e2n: gi\u1ea3m nh\u1eadn c\u1ea3m ki\u1ec3u b\u00edt t\u1ea5t ng\u1eafn. T\u0103ng s\u1eebng h\u00f3a m\u1ea1nh \u1edf b\u00e0n ch\u00e2n, gi\u1eefa c\u00e1c m\u1ea3ng s\u1eebng h\u00e1o c\u00f3 c\u00e1c \u1ed5 lo\u00e9t s\u00e2u.<\/p>\n

– Vi\u00eam \u0111a d\u00e2y TK: t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng \u0111\u1ed1i x\u1ee9ng, hay g\u1eb7p \u1edf chi d\u01b0\u1edbi, v\u00f9ng ng\u1ecdn chi, r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c, gi\u1ea3m v\u00e0 m\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng. Nh\u1eefng r\u1ed1i lo\u1ea1n TK th\u01b0\u1eddng hay g\u1eb7p v\u00e0 c\u0169ng r\u1ea5t s\u1edbm.<\/p>\n

v TK ngo\u1ea1i bi\u00ean: g\u00e2y li\u1ec7t, teo c\u01a1 v\u00e0 r\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c, \u0111au, d\u1ecb c\u1ea3m, gi\u1ea3m ho\u1eb7c m\u1ea5t ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng<\/p>\n

v T\u1ed5n th\u01b0\u01a1ng h\u1ec7 TK TV: Tim m\u1ea1ch: h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf, nh\u1ecbp tim nhanh<\/p>\n

Ti\u1ebft ni\u1ec7u, sinh d\u1ee5c: b\u00ed \u0111\u00e1i, li\u1ec7t d\u01b0\u01a1ng, xu\u1ea5t tinh ng\u01b0\u1ee3c d\u00f2ng<\/p>\n

Ti\u00eau h\u00f3a: \u0111au d\u1ea1 d\u00e0y, \u1ec9a l\u1ecfng do r\u1ed1i lo\u1ea1n nhu \u0111\u1ed9ng ru\u1ed9t<\/p>\n

Lo\u00e9t gan b\u00e0n ch\u00e2n.<\/p>\n

C\u00e2u 56: Tr\u00ecnh b\u00e0y c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y h\u00f4n m\u00ea v\u00e0 ph\u00e2n \u0111\u1ed9 h\u00f4n m\u00ea theo thang \u0111i\u1ec3m Glasgow.<\/p>\n

1. C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y h\u00f4n m\u00ea:<\/p>\n

a. Do tu\u1ea7n ho\u00e0n n\u00e3o b\u1ecb \u1ea3nh h\u01b0\u1edfng<\/p>\n

– T\u1ee5t huy\u1ebft \u00e1o n\u1eb7ng<\/p>\n

– Ng\u1ea5t<\/p>\n

– R\u1ed1i lo\u1ea1n nh\u1ecbp tim: nh\u1ecbp tim qu\u00e1 ch\u1eadm <30 ho\u1eb7c qu\u00e1 nhanh >160 chu k\u1ef3\/ph\u00fat<\/p>\n

– Tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o: xu\u1ea5t huy\u1ebft n\u00e3o c\u00f3 tr\u00e0n n\u00e3o th\u1ea5t ho\u1eb7c xu\u1ea5t huy\u1ebft n\u00e3o do t\u0103ng huy\u1ebft \u00e1p v\u00ec c\u00f3 \u1ea3nh h\u01b0\u1eddng \u0111\u1ebfn c\u00f9ng h\u1ea1 n\u00e3o; nh\u1ed3i m\u00e1u n\u00e3o v\u00f9ng c\u1ea7u n\u00e3o v\u00e0 tr\u00ean cu\u1ed1ng n\u00e3o; ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/p>\n

b. Do \u1ea3nh h\u01b0\u1eddng \u0111\u1ebfn chuy\u1ec3n h\u00f3a \u1edf n\u00e3o<\/p>\n

– B\u1ec7nh chuy\u1ec3n h\u00f3a v\u00e0 n\u1ed9i ti\u1ebft: \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, suy ho\u1eb7c c\u01b0\u1eddng gi\u00e1p, u tuy\u1ebfn t\u1ee5y<\/p>\n

– R\u1ed1i lo\u1ea1n n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i: t\u0103ng ho\u1eb7c gi\u1ea3m Na+, t\u0103ng Ca++ m\u00e1u…<\/p>\n

– Nhi\u1ec5m \u0111\u1ed9c n\u1ed9i sinh: suy gan,suy th\u1eadn<\/p>\n

– Suy h\u00f4 h\u1ea5p n\u1eb7ng<\/p>\n

– Ph\u00f9 n\u00e3o:t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd,u n\u00e3o,vi\u00eam ho\u1eb7c \u00e1p xe n\u00e3o- m\u00e0ng n\u00e3o,s\u1ed1t r\u00e9t \u00e1c t\u00ednh,ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o.<\/p>\n

– Ng\u1ed9 \u0111\u1ed9c: thu\u1ed1c ng\u1ee7, r\u01b0\u1ee3u, ma t\u00fay, phospho h\u1eefu c\u01a1…<\/p>\n

c. Nguy\u00ean nh\u00e2n do r\u1ed1i lo\u1ea1n \u0111i\u1ec7n n\u00e3o.<\/p>\n

– Ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/p>\n

– \u0110\u1ed9ng kinh<\/p>\n

2. Ph\u00e2n \u0111\u1ed9 h\u00f4n m\u00ea theo thang \u0111i\u1ec3m Glasgow:<\/p>\n

\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 h\u00f4n m\u00ea c\u0169ng nh\u01b0 ti\u1ebfn tri\u1ec3n h\u00f4n m\u00ea t\u1ed1t h\u01a1n ph\u00e2n lo\u1ea1i kinh \u0111i\u1ec3n<\/p>\n

Th\u1eed nghi\u1ec7m<\/p>\n

\u0110\u00e1p \u1ee9ng<\/p>\n

\u0110i\u1ec3m<\/p>\n

\u0110\u00e1p \u1ee9ng m\u1edf m\u1eaft<\/p>\n

– M\u1edf m\u1eaft t\u1ef1 nhi\u1ec7n<\/p>\n

– M\u1edf m\u1eaft khi g\u1ecdi<\/p>\n

– M\u1edf m\u1eaft khi k\u00edch th\u00edch \u0111au<\/p>\n

– L\u00e0m g\u00ec c\u0169ng kh\u00f4ng m\u1edf m\u1eaft<\/p>\n

4<\/p>\n

3<\/p>\n

2<\/p>\n

1<\/p>\n

\u0110\u00e1p \u1ee9ng v\u1edbi l\u1eddi n\u00f3i<\/p>\n

– Nhanh, ch\u00ednh x\u00e1c<\/p>\n

– Ch\u1eadm, kh\u00f4ng ch\u00ednh x\u00e1c<\/p>\n

– Tr\u1ea3 l\u1eddi l\u1ed9n x\u1ed9n<\/p>\n

– Tr\u1ea3 l\u1eddi b\u1eb1ng \u00e2m thanh v\u00f4 ngh\u0129a<\/p>\n

– Kh\u00f4ng tr\u1ea3 l\u1eddi g\u00ec c\u1ea3<\/p>\n

5<\/p>\n

4<\/p>\n

3<\/p>\n

2<\/p>\n

1<\/p>\n

\u0110\u00e1p \u1ee9ng v\u1eadn \u0111\u1ed9ng<\/p>\n

– \u0110\u00fang theo y l\u1ec7nh<\/p>\n

– B\u1ea5u \u0111au: g\u1ea1t \u0111\u00fang ch\u1ed7<\/p>\n

– B\u1ea5u \u0111au: g\u1ea1t kh\u00f4ng \u0111\u00fang ch\u1ed7<\/p>\n

– G\u1ea5p c\u1ee9ng 2 tay<\/p>\n

– Du\u1ed7i c\u1ee9ng t\u1ee9 chi<\/p>\n

– N\u1eb1m y\u00ean kh\u00f4ng \u0111\u00e1p \u1ee9ng<\/p>\n

6<\/p>\n

5<\/p>\n

4<\/p>\n

3<\/p>\n

2<\/p>\n

1<\/p>\n

– T\u1ed5ng \u0111i\u1ec3m<\/p>\n

15<\/p>\n

T\u1ec9nh t\u00e1o ho\u00e0n to\u00e0n<\/p>\n

11-14<\/p>\n

H\u00f4n m\u00ea nh\u1eb9<\/p>\n

6-10<\/p>\n

H\u00f4n m\u00ea v\u1eeba<\/p>\n

4-5<\/p>\n

H\u00f4n m\u00ea s\u00e2u<\/p>\n

3<\/p>\n

H\u00f4n m\u00ea qu\u00e1 s\u00e2u<\/p>\n

3. Ph\u00e2n lo\u1ea1i h\u00f4n m\u00ea theo l\u00e2m s\u00e0ng: kinh \u0111i\u1ec3n<\/p>\n

– G\u0110 I: BN l\u01a1 m\u01a1, \u0111\u00e1p \u1ee9ng ch\u1eadm (tr\u1ea3 l\u1eddi ch\u1eadm, khi \u0111\u00fang khi sai); c\u00f2n \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi k\u00edch th\u00edch \u0111au (g\u1ea1c \u0111\u00fang ch\u1ed7), c\u00e1c ph\u1ea3n x\u1ea1 c\u00f2n t\u1ed1t<\/p>\n

– G\u0110 II: kh\u00f4ng c\u00f3 ph\u1ea3n \u1ee9ng th\u1ee9c t\u1ec9nh (g\u1ecdi h\u1ecfi kh\u00f4ng \u0111\u00e1p \u1ee9ng), ph\u1ea3n \u1ee9ng v\u1eadn \u0111\u1ed9ng ph\u00f9 h\u1ee3p (g\u1ea1c kh\u00f4ng \u0111\u00fang ch\u1ed7); r\u1ed1i lo\u1ea1n ph\u1ea3n x\u1ea1 (m\u1ea5t ph\u1ea3n x\u1ea1 tr\u00e1n v\u00e0 th\u1ecb mi; c\u00f2n ph\u1ea3n x\u1ea1 gi\u00e1c m\u1ea1c v\u00e0 nu\u1ed1t)<\/p>\n

– G\u0110 III: h\u00f4n m\u00ea s\u00e2u v\u1edbi kg \u0111\u00e1p \u1ee9ng k\u00edch th\u00edch \u0111au; m\u1ea5t h\u1ebft c\u00e1c p.x\u1ea1 nh\u01b0ng ch\u01b0a c\u00f3 r\u1ed1i lo\u1ea1n TKTV<\/p>\n

– G\u0110 IV: h\u00f4n m\u00ea qu\u00e1 giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng gi\u1ed1ng G\u0110 III nh\u01b0ng k\u00e8m theo r\u1ed1i lo\u1ea1n TKTV (r\u1ed1i lo\u1ea1n nh\u1ecbp tim, nh\u1ecbp th\u1edf, nhi\u1ec7t \u0111\u1ed9 v\u00e0 h\u1ea1 HA)<\/p>\n","protected":false},"excerpt":{"rendered":"

  T\u00f3m t\u1eaft (Gi\u1edbi h\u1ea1n): Kh\u00e1m b\u1ec7nh tim m\u1ea1ch – tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng trong th\u0103m kh\u00e1m tim – c\u01a1 ch\u1ebf c\u1ee7a 7 ti\u1ebfng tim th\u01b0\u1eddng g\u1eb7p khi nghe tim – c\u01a1 ch\u1ebf g\u00e2y ra ti\u1ebfng th\u1ed5i \u1edf tim – m\u00f4 t\u1ea3 ti\u1ebfng tim khi nghe tim trong th\u0103m kh\u00e1m h\u1ec7 tim m\u1ea1ch – ph\u00e2n …<\/p>\n","protected":false},"author":10,"featured_media":2202,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[51,52],"tags":[],"class_list":["post-2269","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-noi-khoa","category-noi-co-so"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2269","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=2269"}],"version-history":[{"count":5,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2269\/revisions"}],"predecessor-version":[{"id":2315,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2269\/revisions\/2315"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/2202"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=2269"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=2269"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=2269"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}