{"id":2277,"date":"2022-07-13T23:15:29","date_gmt":"2022-07-13T16:15:29","guid":{"rendered":"https:\/\/ykhoataynguyen.com\/site\/?p=2277"},"modified":"2022-07-14T22:55:35","modified_gmt":"2022-07-14T15:55:35","slug":"tai-lieu-de-cuong-soan","status":"publish","type":"post","link":"https:\/\/ykhoataynguyen.com\/site\/tai-lieu-de-cuong-soan\/","title":{"rendered":"\u0110\u1ec1 c\u01b0\u01a1ng Ngo\u1ea1i c\u01a1 s\u1edf, K14 (Tham kh\u1ea3o)"},"content":{"rendered":"

C\u00e2u 1: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 bi\u1ebfn ch\u1ee9ng v\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m?<\/p>\n

C\u00e2u 2: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a v\u00e0 ph\u00e2n lo\u1ea1i v\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m?<\/p>\n

C\u00e2u 3: Tr\u00ecnh b\u00e0y c\u00e1c giai \u0111o\u1ea1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ecfng?<\/p>\n

C\u00e2u 4: Tr\u00ecnh b\u00e0y c\u00e1c giai \u0111o\u1ea1n c\u1ee7a m\u00ea?<\/p>\n

C\u00e2u 5: Tr\u00ecnh b\u00e0y c\u00e1ch ph\u00e2n lo\u1ea1i vi\u00eam ph\u00fac m\u1ea1c<\/p>\n

C\u00e2u 6: Tr\u00ecnh b\u00e0y c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng vi\u00eam ph\u00fac m\u1ea1c<\/p>\n

C\u00e2u 7: Tr\u00ecnh b\u00e0y c\u00e1ch ph\u00e2n bi\u1ec7t vi\u00eam ph\u00fac m\u1ea1c v\u1edbi h\u1ed9i ch\u1ee9ng ch\u1ea3y m\u00e1u trong \u1ed5 b\u1ee5ng v\u1edbi t\u1eafc ru\u1ed9t c\u01a1 h\u1ecdc<\/p>\n

C\u00e2u 8: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng th\u01b0\u1eddng g\u1eb7p c\u1ee7a kh\u00e1m h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng<\/p>\n

C\u00e2u 9: Tr\u00ecnh b\u00e0y c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 khi kh\u00e1m h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng?<\/p>\n

C\u00e2u 10: Tr\u00ecnh b\u00e0y c\u1eadn l\u00e2m s\u00e0ng c\u1ea7n thi\u1ebft khi kh\u00e1m h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng<\/p>\n

C\u00e2u 11: Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng c\u1ee7a m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng v\u00e0 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng<\/p>\n

C\u00e2u 12: C\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng c\u1ed9t s\u1ed1ng:<\/p>\n

C\u00e2u 13: Ph\u00e2n t\u00edch 3 giai \u0111o\u1ea1n di\u1ec5n ti\u1ebfn c\u1ee7a bong g\u00e2n v\u1ec1 m\u1eb7t sinh l\u00fd b\u1ec7nh<\/p>\n

C\u00e2u 14: \u0110i\u1ec1u tr\u1ecb bong g\u00e2n:<\/p>\n

C\u00e2u 15: Tr\u00ecnh b\u00e0y ph\u00e2n lo\u1ea1i theo Gustilo v\u00e0 ch\u1ec9 s\u1ed1 ch\u1ea5n th\u01b0\u01a1ng trong g\u00e3y x\u01b0\u01a1ng h\u1edf?<\/p>\n

C\u00e2u 16: ph\u00e2n loai b\u1ecfng theo chi\u1ec1u s\u00e2u v\u00e0 di\u1ec7n t\u00edch ?<\/p>\n

C\u00e2u 17: Tr\u00ecnh b\u00e0y c\u00e1c nguy\u00ean nh\u00e2n v\u00e0 ph\u00e2n lo\u1ea1i b\u1ecfng theo quy lu\u1eadt s\u1ed1 9(Wallace)<\/p>\n

C\u00e2u 18: Bi\u1ebfn ch\u1ee9ng c\u1ee7a g\u00e2y t\u00ea<\/p>\n

C\u00e2u 19: Tr\u00ecnh b\u00e0y sinh h\u1ecdc v\u1ebft th\u01b0\u01a1ng v\u00e0 s\u1ef1 li\u1ec1n v\u1ebft th\u01b0\u01a1ng:<\/p>\n

C\u00e2u 20: C\u00e1c th\u01b0\u01a1ng t\u1ed5n th\u1ee9 ph\u00e1t g\u00e2y t\u1ed5n th\u01b0\u01a1ng n\u00e3o theo c\u01a1 ch\u1ebf n\u00e0o? C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u1edf BN ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o?<\/p>\n

C\u00e2u 21: m\u00f4 t\u1ea3 c\u00e1c nghi\u1ec7m ph\u00e1p hay d\u1ea5u hi\u1ec7u trong kh\u00e1m b\u1ee5ng ngo\u1ea1i khoa? Gi\u1ea3i th\u00edch c\u00e1c \u1ee9ng d\u1ee5ng?<\/p>\n

C\u00e2u 22: H\u00e3y n\u00eau c\u00e1c n\u1ed9i dung chu\u1ea9n b\u1ecb BN tr\u01b0\u1edbc m\u1ed5; Y ngh\u0129a c\u1ee7a vi\u1ec7c chu\u1ea9n b\u1ecb n\u00e0y.<\/p>\n

C\u00e2u 23: Tr\u00ecnh b\u00e0y ch\u0103m s\u00f3c BN sau m\u1ed5 t\u1ea1i ph\u00f2ng h\u1eadu ph\u1ea9u?C\u00e2u 24: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 bi\u1ebfn ch\u1ee9ng g\u00e3y x\u01b0\u01a1ng h\u1edf?<\/p>\n

C\u00c2U 25: Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng t\u1eafc m\u1eadt<\/p>\n

C\u00c2U 26: Tr\u00ecnh b\u00e0y nguy\u00ean nh\u00e2n g\u00e2y t\u1eafc m\u1eadt th\u01b0\u1eddng g\u1eb7p .<\/p>\n

C\u00c2U 27: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng t\u1eafc ru\u1ed9t.<\/p>\n

C\u00e2u 28: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng c\u1eadn l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng t\u1eafc ru\u1ed9t.<\/p>\n

C\u00e2u 29: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a, nguy\u00ean nh\u00e2n ch\u1ea3y m\u00e1u trong.<\/p>\n

C\u00e2u 30: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng ch\u1ea3y m\u00e1u trong.<\/p>\n

C\u00e2u 31: Tr\u00ecnh b\u00e0y h\u1ed9i ch\u1ee9ng b\u00e0ng quang k\u00edch th\u00edch va h\u1ed9i ch\u1ee9ng t\u1eafc ngh\u1ebdn:<\/p>\n

C\u00e2u 32: Tr\u00ecnh b\u00e0y c\u00e1c CLS trong th\u0103m kh\u00e1m h\u1ec7 ti\u1ebft ni\u1ec7u sinh d\u1ee5c?<\/p>\n

C\u00e2u 33: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 x\u1eed l\u00fd tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i?<\/p>\n

C\u00e2u 34: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a, tri\u1ec7u ch\u1ee9ng v\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a m\u1ea3ng s\u01b0\u1eddn di \u0111\u1ed9ng?<\/p>\n

C\u00e2u 35: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 nguy\u00ean nh\u00e2n g\u00e3y x\u01b0\u01a1ng?<\/p>\n

C\u00e2u 36: Tr\u00ecnh b\u00e0y c\u00e1c di l\u1ec7ch trong g\u00e3y x\u01b0\u01a1ng v\u00e0 n\u00eau c\u00e1c bi\u1ebfn ch\u1ee9ng trong g\u00e3y x\u01b0\u01a1ng?<\/p>\n

C\u00e2u 37: (c\u00e1c d\u1ea5u hi\u1ec7u)Tr\u00ecnh b\u00e0y \u0111\u1ed9ng t\u00e1c “s\u1edd” trong th\u0103m kh\u00e1m b\u1ee5ng ngo\u1ea1i khoa? Tr\u00ecnh b\u00e0y c\u00e1c tri\u1ec7u ch\u1ee9ng thu \u0111\u01b0\u1ee3c khi s\u1edd n\u1eafn trong qu\u00e1 tr\u00ecnh kh\u00e1m b\u1ee5ng \u1edf ngo\u1ea1i khoa?<\/p>\n

C\u00e2u 38: Tr\u00ecnh b\u00e0y c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a g\u00e2y m\u00ea?<\/p>\n

C\u00e2u 39: Tr\u00ecnh b\u00e0y c\u00e1ch ph\u00e2n khu v\u00f9ng b\u1ee5ng v\u00e0 c\u00e1c \u0111i\u1ec3m \u0111au \u1edf th\u00e0nh b\u1ee5ng?<\/p>\n

C\u00e2u 40: Tr\u00ecnh b\u00e0y c\u00e1c tri\u1ec7u ch\u1ee9ng thu \u0111\u01b0\u1ee3c khi nh\u00ecn trong qu\u00e1 tr\u00ecnh kh\u00e1m b\u1ee5ng ngo\u1ea1i khoa?<\/p>\n

C\u00e2u 41: Tr\u00ecnh b\u00e0y c\u00e1c r\u1ed1i lo\u1ea1n ti\u1ec3u ti\u1ec7n khi kh\u00e1m h\u1ec7 ti\u1ebft ni\u1ec7u?<\/p>\n

C\u00e2u 42: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m th\u1eadn to v\u00e0 c\u00e1c \u0111i\u1ec3m ni\u1ec7u qu\u1ea3n?<\/p>\n

C\u00e2u 43: Tr\u00ecnh b\u00e0y ph\u01b0\u01a1ng ph\u00e1p ti\u1ec7t khu\u1ea9n b\u1eb1ng bi\u1ec7n ph\u00e1p h\u00f3a h\u1ecdc?<\/p>\n

C\u00e2u 44: Tr\u00ecnh b\u00e0y sinh l\u00fd b\u1ec7nh v\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ee7a t\u1eafc ru\u1ed9t<\/p>\n

C\u00e2u 45: Tr\u00ecnh b\u00e0y gi\u1ea3i ph\u1ea9u b\u1ec7nh v\u00e0 chu\u1ea9n \u0111o\u00e1n g\u00e3y x\u01b0\u01a1ng h\u1edf?<\/p>\n

C\u00e2u 46: tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a tr\u00e0n m\u00e1u m\u00e0ng ph\u1ed5i<\/p>\n

C\u00e2u 47: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m tri gi\u00e1c v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng trong ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u1ea3o?<\/p>\n

C\u00e2u 48: Tr\u00ecnh b\u00e0y c\u01a1 ch\u1ebf kh\u00e1m ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o?<\/p>\n

C\u00e2u 49: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 bi\u1ebfn ch\u1ee9ng trong g\u00e3y x\u01b0\u01a1ng?<\/p>\n

C\u00e2u 50: Ph\u00e2n bi\u1ec7t gi\u1eefa li\u1ec7t ho\u00e0n to\u00e0n v\u00e0 li\u1ec7t kh\u00f4ng ho\u00e0n to\u00e0n?C\u00e2u 1: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 bi\u1ebfn ch\u1ee9ng v\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m?<\/p>\n

A. TRI\u1ec6U CH\u1ee8NG<\/p>\n

I.\u0110\u1ebfn s\u1edbm<\/p>\n

1.To\u00e0n th\u00e2n:Th\u01b0\u1eddng kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u g\u00ec \u0111\u1eb7c bi\u1ec7t. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p s\u1ed1c do m\u1ea5t m\u00e1u, do \u0111au g\u1eb7p trong tr\u01b0\u1eddng b\u1ecb l\u00f3c da r\u1ed9ng, c\u00f3 t\u1ed5n th\u01b0\u01a1ng ph\u1ed1i h\u1ee3p.<\/p>\n

2. C\u01a1 n\u0103ng: -\u0110au r\u00e1t t\u1ea1i v\u1ebft th\u01b0\u01a1ng, \u0111au gi\u1ea3m khi \u0111\u01b0\u1ee3c c\u1ed1 \u0111\u1ecbnh.<\/p>\n

– Gi\u1ea3m c\u01a1 n\u0103ng nh\u1ea5t l\u00e0 v\u1ebft th\u01b0\u01a1ng \u1edf v\u00f9ng kh\u1edbp (c\u1ed5 tay, c\u1ed5 ch\u00e2n).<\/p>\n

3. Th\u1ef1c th\u1ec3: \u0110a d\u1ea1ng:<\/p>\n

– V\u1ebft th\u01b0\u01a1ng s\u1eafc g\u1ecdn c\u00f3 m\u00e1u ch\u1ea3y qua v\u1ebft th\u01b0\u01a1ng ho\u1eb7c \u0111\u00e3 ng\u1eebng ch\u1ea3y.<\/p>\n

-V\u1ebft th\u01b0\u01a1ng d\u1eadp n\u00e1t c\u00f3 d\u1ecb v\u1eadt t\u1ea1i v\u1ebft th\u01b0\u01a1ng.<\/p>\n

– V\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1n c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p v\u1edbi \u0111\u1ee9t m\u1ea1ch m\u00e1u, \u0111\u1ee9t th\u1ea7n kinh, g\u00e3y x\u01b0\u01a1ng, t\u1ed5n th\u01b0\u01a1ng kh\u1edbp.<\/p>\n

II. \u0110\u1ebfn mu\u1ed9n<\/p>\n

1.To\u00e0n th\u00e2n: Bi\u1ec3u hi\u1ec7n h\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng: S\u1ed1t, m\u00f4i kh\u00f4, l\u01b0\u1ee1i b\u1ea9n, h\u01a1i th\u1edf h\u00f4i.<\/p>\n

2. C\u01a1 n\u0103ng:- \u0110au nh\u1ee9c t\u1ea1i v\u1ebft th\u01b0\u01a1ng<\/p>\n

-Gi\u1ea3m ho\u1eb7c m\u1ea5t c\u01a1 n\u0103ng chi.<\/p>\n

3. Th\u1ef1c th\u1ec3: C\u00f3 hai kh\u1ea3 n\u0103ng: – V\u1ebft th\u01b0\u01a1ng s\u01b0ng, n\u00f3ng, \u0111\u1ecf, \u0111au.<\/p>\n

– V\u1ebft th\u01b0\u01a1ng c\u00f3 d\u1ecbch m\u1ee7, m\u00f9i h\u00f4i.<\/p>\n

* Khi kh\u00e1m c\u1ea7n x\u00e1c \u0111\u1ecbnh:- Th\u1eddi gian b\u1ecb v\u1ebft th\u01b0\u01a1ng<\/p>\n

– Nguy\u00ean nh\u00e2n, t\u00e1c nh\u00e2n g\u00e2y v\u1ebft th\u01b0\u01a1ng.<\/p>\n

– M\u00f4i tr\u01b0\u1eddng xung quanh s\u1ea1ch hay b\u1ea9n.<\/p>\n

– \u0110\u01b0\u1ee3c s\u01a1 c\u1ee9u nh\u01b0 th\u1ebf n\u00e0o.<\/p>\n

– V\u1ecb tr\u00ed k\u00edch th\u01b0\u1edbc c\u1ee7a v\u1ebft th\u01b0\u01a1ng, v\u1ebft th\u01b0\u01a1ng s\u1ea1ch hay b\u1ea9n.<\/p>\n

B. BI\u1ebeN CH\u1ee8NG :<\/p>\n

1. Ch\u1ea3y m\u00e1u :<\/p>\n

– M\u00e1u t\u1ee5 \u1ee9 \u0111\u1ecdng t\u1ea1i v\u1ebft th\u01b0\u01a1ng v\u00e0 \u1ee9 \u0111\u1ecdng d\u01b0\u1edbi c\u00e2n g\u00e2y ch\u00e8n \u00e9p d\u00e2n \u0111\u1ebfn t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy m\u00e1u t\u1ea1i v\u1ebft th\u01b0\u01a1ng g\u00e2y h\u1eadu qu\u1ea3 nhi\u1ec5m tr\u00f9ng, v\u1ebft th\u01b0\u01a1ng kh\u00f3 l\u00e0nh.<\/p>\n

– N\u1ebfu m\u00e1u m\u1ea5t nhi\u1ec1u s\u1ebd c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y cho\u00e1ng ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n

2. Nhi\u1ec5m tr\u00f9ng: V\u1ebft th\u01b0\u01a1ng nhi\u1ec5m tr\u00f9ng ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1c \u0111i\u1ec1u ki\u1ec7n sau \u0111\u00e2y:<\/p>\n

– S\u1ef1 ki\u1ec7n c\u1ee7a vi khu\u1ea9n<\/p>\n

– \u0110i\u1ec1u ki\u1ec7n t\u1ea1i ch\u1ed7 c\u1ee7a v\u1ebft th\u01b0\u01a1ng v\u00e0 to\u00e0n th\u00e2n ng\u01b0\u1eddi b\u1ec7nh<\/p>\n

n\u1ebfu v\u1ebft th\u01b0\u01a1ng d\u1eadp n\u00e1t c\u00e0ng nhi\u1ec1u th\u00ec m\u1ee9c \u0111\u1ed9 nhi\u1ec5m tr\u00f9ng c\u00e0ng cao .<\/p>\n

– S\u1ee9c \u0111\u1ec1 kh\u00e1ng c\u01a1 th\u1ec3 y\u1ebfu m\u1ee9c \u0111\u1ed9 nhi\u1ec5m tr\u00f9ng c\u00e0ng cao .<\/p>\n

* Bi\u1ec3u hi\u1ec7n: – S\u01b0ng, n\u00f3ng \u0111\u1ecf t\u1ea1i v\u1ebft th\u01b0\u01a1ng<\/p>\n

– S\u1ed1t<\/p>\n

– X\u00e9t nghi\u1ec7m m\u00e1u: B\u1ea1ch c\u1ea7u t\u0103ng<\/p>\n

3. Khuy\u1ebft m\u1ea5t m\u00f4: C\u00e1c m\u00f4 ho\u1ea1i t\u1eed d\u1eadp n\u00e1t t\u1ef1 ti\u00eau h\u1ee7y g\u00e2y n\u00ean t\u00ecnh tr\u1ea1ng khuy\u1ebft m\u1ea5t m\u00f4 t\u1ea1i v\u1ebft th\u01b0\u01a1ng<\/p>\n

C\u00e2u 2: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a v\u00e0 ph\u00e2n lo\u1ea1i v\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m?<\/p>\n

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

– V\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m l\u00e0 nh\u1eefng th\u01b0\u01a1ng t\u00edch g\u00e2y t\u1ed5n th\u01b0\u01a1ng da, m\u00f4li\u00ean k\u1ebft d\u01b0\u1edbi da, c\u00e2n v\u00e0 c\u01a1.<\/p>\n

– V\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m c\u00f3 th\u1ec3 ch\u1ec9 l\u00e0 nh\u1eefng v\u1ebft th\u01b0\u01a1ng c\u1eaft g\u1ecdn, c\u0169ng c\u00f3 th\u1ec3 l\u00e0 c\u00e1c v\u1ebft th\u01b0\u01a1ng gi\u1eadp n\u00e1t<\/p>\n

– V\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m chi\u1ebfm 1 t\u1ec9 l\u1ec7 cao trong s\u1ed1 c\u00e1c v\u1ebft th\u01b0\u01a1ng n\u00f3i chung. Trong ch\u1ea5n th\u01b0\u01a1ng g\u00e3y x\u01b0\u01a1ng vi\u1ec7c \u0111\u00e1nh gi\u00e1 v\u00e0 ph\u00e2n lo\u1ea1i g\u00e3y x\u01b0\u01a1ng (h\u1edf v\u00e0 k\u00edn) \u0111\u1ec1u c\u1ea7n c\u00f3 s\u1ef1 \u0111\u00e1nh gi\u00e1 x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m<\/p>\n

– X\u1eed l\u00ed t\u1ed1t v\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m l\u00e0 \u0111i\u1ec1u ki\u1ec7n c\u0103n b\u1ea3n \u0111\u1ea7u ti\u00ean g\u00f3p ph\u1ea7n \u0111i\u1ec1u tr\u1ecb t\u1ed1t c\u00e1c v\u1ebft th\u01b0\u01a1ng ngo\u1ea1i khoa, nh\u1ea5t l\u00e0 trong ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh<\/p>\n

II. Nguy\u00ean nh\u00e2n v\u00e0 ph\u00e2n lo\u1ea1i: tu\u1ef3 theo v\u1ebft th\u01b0\u01a1ng ta c\u00f3 th\u1ec3 ph\u00e2n l\u00e0m 4 lo\u1ea1i sau:<\/p>\n

1. C\u00e1c v\u1ebft \u0111\u00e2m ch\u1ecdc nh\u1ecf(v\u1ebft th\u01b0\u01a1ng lo\u1ea1i 1)<\/p>\n

* Nguy\u00ean nh\u00e2n: Th\u01b0\u1eddng do c\u00e1c v\u1eadt s\u1eafc nh\u1ecdn: kim \u0111\u00e2m, m\u1ea3nh \u1ed1ng ti\u00eam, r\u0103ng s\u00fac v\u1eadt c\u1eafn…..<\/p>\n

* T\u1ed5n th\u01b0\u01a1ng: t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1ea9u kg \u0111\u00e1ng k\u1ec3. T\u00f9y theo chi\u1ec1u d\u00e0i c\u1ee7a v\u1eadt nh\u1ecdn g\u00e2y th\u01b0\u01a1ng t\u00edch m\u00e0 c\u00f3 th\u1ec3 t\u1ed5n th\u01b0\u01a1ng \u0111i s\u00e2u v\u00e0o c\u00e1c t\u1ed5 ch\u1ee9c m\u00f4 m\u1ec1m g\u00e2y ra s\u1ef1 lan truy\u1ec1n nhi\u1ec5m tr\u00f9ng t\u1eeb ngo\u00e0i v\u00e0o c\u00e1c l\u1edbp m\u1ee1, c\u01a1 khoang k\u00edn<\/p>\n

* Nguy c\u01a1: Nguy c\u01a1 ch\u00ednh l\u00e0 nhi\u1ec5m tr\u00f9ng m\u1ee9c \u0111\u1ed9 \u00edt. Ngo\u00e0i ra c\u00f2n c\u00f3 th\u1ec3 \u0111au nh\u1ee9c, nhi\u1ec5m tr\u00f9ng u\u1ed1n v\u00e1n, nguy c\u01a1 l\u00e2y nhi\u1ec5m HIV<\/p>\n

2. C\u00e1c v\u1ebft c\u1eaft g\u1ecdn (v\u1ebft th\u01b0\u01a1ng lo\u1ea1i 2)<\/p>\n

* Nguy\u00ean nh\u00e2n: T\u00e1c nh\u00e2n g\u00e2y ra l\u00e0 c\u00e1c v\u1eadt s\u1eafc b\u00e9n nh\u01b0 dao, m\u00e1y c\u1eaft c\u00f4ng nghi\u1ec7p, m\u1ea3nh k\u00ednh, t\u00f4n…<\/p>\n

* T\u1ed5n th\u01b0\u01a1ng: T\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1ea9u \u1edf m\u1ee9c \u0111\u1ed9 \u0111\u00e1ng k\u1ec3, th\u01b0\u1eddng khu tr\u00fa. V\u1ebft th\u01b0\u01a1ng c\u00f3 th\u1ec3 r\u1ed9ng v\u00e0 s\u00e2u, t\u1ed5n th\u01b0\u01a1ng d\u01b0\u1edbi da v\u00e0 c\u01a1 g\u00e2y ra s\u1ef1 ch\u1ea3y m\u00e1u v\u1ebft th\u01b0\u01a1ng<\/p>\n

* Nguy c\u01a1: Ngo\u00e0i nh\u1eefng nguy c\u01a1 nh\u01b0 v\u1ebft th\u01b0\u01a1ng \u0111\u00e2m ch\u1ecdc nh\u1ecf, c\u00f2n c\u00f3 4 v\u1ea5n \u0111\u1ec1 \u0111\u1eb7t ra:<\/p>\n

– C\u1ea5p c\u1ee9u: Ph\u1ea3i l\u00e0m ng\u1eebng ch\u1ea3y m\u00e1u<\/p>\n

– Ch\u1ea9n \u0111o\u00e1n: Ph\u1ea3i li\u1ec7t k\u00ea \u0111\u1ea7y \u0111\u1ee7 c\u00e1c m\u00f4 b\u1ecb t\u1ed5n th\u01b0\u01a1ng<\/p>\n

– \u0110i\u1ec1u tr\u1ecb: Ph\u1ea3i ph\u1ee5c h\u1ed3i k\u1ec3 c\u1ea3 gi\u1ea3i ph\u1ea9u v\u00e0 ch\u1ee9c n\u0103ng<\/p>\n

– Theo d\u00f5i: Tr\u00e1nh ph\u00f9 n\u1ec1 v\u00e0 nhi\u1ec5m tr\u00f9ng v\u1ebft th\u01b0\u01a1ng<\/p>\n

3. V\u1ebft th\u01b0\u01a1ng tr\u00f3c da<\/p>\n

* Nguy\u00ean nh\u00e2n: Do m\u1ed9t va ch\u1ea1m m\u00f3c v\u00e0o da ho\u1eb7c 1 m\u1ea3ng da b\u1ecb tr\u00f3c ra ho\u00e0n to\u00e0n kh\u1ecfi c\u01a1 th\u1ec3 do tai n\u1ea1n gi\u1ea3o th\u00f4ng ho\u1eb7c tai n\u1ea1n lao \u0111\u1ed9ng g\u00e2y ra<\/p>\n

* T\u1ed5n th\u01b0\u01a1ng: V\u00f9ng t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p l\u00e0 da \u0111\u1ea7u, l\u01b0ng v\u00e0 t\u1ee9 chi. Th\u01b0\u01a1ng t\u1ed5n ch\u1ec9 l\u00e0 da v\u00e0 m\u00f4 d\u01b0\u1edbi da, nh\u01b0ng c\u0169ng c\u00f3 khi t\u1edbi c\u01a1 v\u00e0 m\u00e0ng x\u01b0\u01a1ng<\/p>\n

* Nguy c\u01a1:<\/p>\n

– Nhi\u1ec5m tr\u00f9ng cao<\/p>\n

– Ho\u1ea1i t\u1eed da v\u00e0 t\u1ed5 ch\u1ee9c d\u01b0\u1edbi da<\/p>\n

– Cho\u00e1ng ch\u1ea5n th\u01b0\u01a1ng<\/p>\n

4. V\u1ebft th\u01b0\u01a1ng gi\u1eadp n\u00e1t (v\u1ebft th\u01b0\u01a1ng lo\u1ea1i 3)<\/p>\n

* Nguy\u00ean nh\u00e2n: Th\u01b0\u1eddng g\u1eb7p trong tai n\u1ea1n lao \u0111\u1ed9ng, tai n\u1ea1n giao th\u00f4ng, chi\u1ebfn tranh<\/p>\n

* T\u1ed5n th\u01b0\u01a1ng: T\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1ea9u tr\u1ea7m tr\u1ecdng: th\u01b0\u1eddng k\u00e8m theo c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c nh\u01b0 g\u00e3y x\u01b0\u01a1ng, m\u1ea1ch m\u00e1u, th\u1ea7n kinh<\/p>\n

* Nguy c\u01a1<\/p>\n

– Cho\u00e1ng ch\u1ea5n th\u01b0\u01a1ng<\/p>\n

– Nhi\u1ec5m trung n\u1eb7ng<\/p>\n

– T\u1eafc m\u1ea1ch m\u00e1u do m\u1ee1<\/p>\n

– Nguy c\u01a1 c\u00f3 th\u1ec3 m\u1ea5t chi ho\u1eb7c li\u00ean quan t\u00ednh m\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh<\/p>\n

C\u00e2u 19: Tr\u00ecnh b\u00e0y sinh h\u1ecdc v\u1ebft th\u01b0\u01a1ng v\u00e0 s\u1ef1 li\u1ec1n v\u1ebft th\u01b0\u01a1ng<\/p>\n

Qu\u00e1 tr\u00ecnh ho\u1ea1i t\u1eed, ph\u00e2n gi\u1ea3i v\u00e0 qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i m\u00f4 m\u1edbi l\u00e0 2 qu\u00e1 tr\u00ecnh t\u00e1c \u0111\u1ed9ng l\u1eabn nhau trong b\u1ea5t k\u1ef3 lo\u1ea1i v\u1ebft th\u01b0\u01a1ng n\u00e0o<\/p>\n

1. Q\u00faa tr\u00ecnh ho\u1ea1i t\u1eed v\u00e0 ph\u00e2n gi\u1ea3i<\/p>\n

l Giai \u0111o\u1ea1n t\u1ef1 ti\u00eau h\u1ee7y<\/p>\n

Trong nh\u1eefng ph\u00fat \u0111\u1ea7u khi b\u1ecb th\u01b0\u01a1ng da r\u00e1ch ch\u1ea3y m\u00e1u, t\u1ee9c th\u00ec c\u00f3 s\u1ef1 t\u00e1c \u0111\u1ed9ng tr\u1edf l\u1ea1i v\u1ebft th\u01b0\u01a1ng l\u00e0m gi\u1ea3m b\u1edbt \u0111i l\u01b0\u1ee3ng m\u00e1u m\u1ea5t nh\u1edd 2 c\u01a1 ch\u1ebf:<\/p>\n

\u00d8 Nh\u1eefng m\u1ea1ch m\u00e1u co l\u1ea1i v\u00e0 \u1ed5n \u0111\u1ecbnh n\u1ed9i m\u00f4. M\u1ea1ch m\u00e1u co l\u1ea1i, c\u01a1 co r\u00fat b\u1edfi t\u00e1c \u0111\u1ed9ng c\u1ee7a thromboxane (TXA2) v\u00e0 t\u00e1c \u0111\u1ed9ng th\u1ee9 ph\u00e1t c\u1ee7a th\u1ea7n kinh n\u1ed9i ti\u1ebft, \u0111au \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh \u1edf b\u1ec1 m\u1eb7t c\u1ee7a v\u1ebft th\u01b0\u01a1ng g\u00e2y ra t\u0103ng ti\u1ebft catecholamine. C\u00e2n b\u1eb1ng n\u1ed9i m\u00f4 \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u1edfi ti\u1ec3u c\u1ea7u k\u1ebft h\u1ee3p v\u1edbi fibrin \u0111\u00f3ng c\u1ee5c trong th\u00e0nh m\u1ea1ch v\u1eebng v\u1ebft th\u01b0\u01a1ng do t\u00e1c \u0111\u1ed9ng c\u1ee7a TXA2, adnosine diphosphate (ADP) v\u00e0 y\u1ebfu t\u1ed1 th\u1ee9 XII<\/p>\n

\u00d8 S\u1ef1 ph\u00e2n h\u1ee7y fibrin l\u00e0 1 qu\u00e1 tr\u00ecnh sinh l\u00fd b\u00ecnh th\u01b0\u1eddng, n\u00f3 ng\u0103n c\u1ea3n s\u1ef1 \u0111\u00f3ng c\u1ee5c lan r\u1ed9ng v\u00e0 s\u1ef1 h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i qu\u00e1 m\u1ee9c.<\/p>\n

l Giai \u0111o\u1ea1n t\u1ef1 l\u00e0m s\u1ea1ch v\u1ebft th\u01b0\u01a1ng<\/p>\n

Sau co m\u1ea1ch l\u00e0 ho\u1ea1t \u0111\u1ed9ng d\u00e3n m\u1ea1ch c\u1ee7a h\u1ea7u h\u1ebft c\u00e1c m\u1ea1ch m\u00e1u nh\u1ecf, \u0111\u00e2y l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a nhi\u1ec1u t\u00e1c \u0111\u1ed9ng c\u1ee7a \u0111i\u1ec1u h\u00f2a th\u1ec3 d\u1ecbch. Trong giai \u0111o\u1ea1n n\u00e0y c\u00f3 \u0111\u1ea7y \u0111\u1ee7 tri\u1ec7u ch\u1ee9ng c\u1ed5 \u0111i\u1ec3n c\u1ee7a vi\u00eam: s\u01b0ng, n\u00f3ng, \u0111\u1ecf, \u0111au. \u0110au l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a prostaglandin s\u1ea3n sinh ra, n\u00f3ng v\u00e0 \u0111\u1ecf do t\u1ed1c \u0111\u1ed9 m\u1ea1ch m\u00e1u t\u0103ng l\u00ean v\u00e0 s\u1ef1 t\u0103ng sinh m\u1ea1ch m\u00e1u, s\u01b0ng l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a s\u1ef1 t\u0103ng t\u00ednh th\u1ea5m c\u1ee7a t\u1ebf b\u00e0o g\u00e2y ph\u00f9 n\u1ec1 c\u00f9ng v\u1edbi s\u1ef1 nhi\u1ec5m khu\u1ea9n g\u00e2y ra.<\/p>\n

2. Q\u00faa tr\u00ecnh ph\u1ee5c h\u1ed3i t\u1ea1o m\u00f4 m\u1edbi<\/p>\n

\u0110i\u1ec1u ki\u1ec7n quy\u1ebft \u0111\u1ecbnh \u0111\u1ec3 l\u00e0nh ho\u00e0n to\u00e0n v\u1ebft th\u01b0\u01a1ng l\u00e0 c\u00f3 \u0111\u1ea7y \u0111\u1ee7 oxygen h\u00f3a, ch\u1ee9c n\u0103ng chuy\u1ec3n h\u00f3a c\u1ee7a t\u1ebf b\u00e0o t\u1ed1t v\u00e0 v\u1ebft th\u01b0\u01a1ng s\u1ea1ch kh\u00f4ng c\u00f3 vi khu\u1ea9n nhi\u1ec5m b\u1ec7nh.<\/p>\n

l Qu\u00e1 tr\u00ecnh l\u00e0nh v\u1ebft th\u01b0\u01a1ng \u0111\u01b0\u1ee3c di\u1ec5n ra d\u01b0\u1edbi 3 h\u00ecnh th\u1ee9c<\/p>\n

\u00d8 T\u1ea1o m\u00f4 h\u1ea1t m\u1edbi: qu\u00e1 tr\u00ecnh n\u00e0y h\u00ecnh th\u00e0nh b\u1edfi s\u1ef1 ho\u1ea1t h\u00f3a v\u00e0 nh\u1eadp c\u01b0 c\u1ee7a nguy\u00ean b\u00e0o s\u1ee3i, s\u1ef1 ph\u00e2n gi\u1ea3i v\u00e0 h\u00ecnh th\u00e0nh protein, s\u1ef1 ph\u00e2n gi\u1ea3i v\u00e0 h\u00ecnh th\u00e0nh collagen v\u00e0 fibronectin, \u0111\u1ed3ng th\u1eddi v\u1edbi s\u1ef1 ph\u00e2n gi\u1ea3i l\u00e0 s\u1ef1 t\u1ea1o l\u1eadp m\u1ea1ch m\u00e1u t\u0103ng sinh do c\u00e1c mao m\u1ea1ch n\u1ed9i m\u00f4 b\u1eaft \u0111\u1ea7u n\u1ea3y n\u1edf. C\u00e1c m\u00f4 h\u1ea1t l\u00e0nh m\u1ea1nh, s\u1ea1ch c\u00f3 m\u00e0u \u0111\u1ecf t\u01b0\u01a1i c\u00f3 k\u00edch th\u01b0\u1edbc b\u1eb1ng \u0111\u1ea7u \u0111inh ghim \u0111\u1ebfn h\u1ea1t \u0111\u1eadu xanh, c\u00f2n c\u00e1c m\u00f4 h\u1ea1t vi\u00eam nhi\u1ec5m c\u00f3 m\u00e0u x\u00e1m xanh. M\u00f4 h\u1ea1t l\u1ea5p \u0111\u1ea7y v\u00f9ng khuy\u1ebft m\u1ea5t m\u00f4 \u0111\u1ed3ng th\u1eddi t\u1ea1o h\u00e0ng r\u00e0o ng\u0103n c\u1ea3n vi khu\u1ea9n v\u00e0 bao ph\u1ee7 b\u1ea3o v\u1ec7 th\u1ea7n kinh, m\u1ea1ch m\u00e1u, g\u00e2n v\u00e0 x\u01b0\u01a1ng b\u1ecb l\u1ed9<\/p>\n

\u00d8 Co r\u00fat thu h\u1eb9p v\u1ebft th\u01b0\u01a1ng, thu nh\u1ecf b\u1edbt di\u1ec7n t\u00edch v\u1ebft th\u01b0\u01a1ng kho\u1ea3ng 50-90% di\u1ec7n t\u00edch ban \u0111\u1ea7u t\u00f9y theo m\u1ee9c \u0111\u1ed9 v\u00e0 v\u00f9ng v\u1ebft th\u01b0\u01a1ng<\/p>\n

\u00d8 L\u1edbp bi\u1ec3u m\u00f4 ph\u1ee7 k\u00edn v\u1ebft th\u01b0\u01a1ng khi \u0111\u00e3 \u0111\u01b0\u1ee3c l\u1ea5p \u0111\u1ea7y m\u00f4 h\u1ea1t. M\u1ed9t v\u1ebft th\u01b0\u01a1ng c\u00f3 m\u00f4 h\u1ea1t s\u1ea1ch ph\u1ee7 \u0111\u1ea7y th\u00ec m\u1ed7i ng\u00e0y thu h\u1eb9p l\u1ea1i v\u00e0 li\u1ec1n l\u1ea1i \u0111\u01b0\u1ee3c t\u1eeb 1-2mm theo \u0111\u01b0\u1eddng k\u00ednh d\u00e0i nh\u1ea5t. Nh\u01b0 v\u1eady c\u00f3 th\u1ec3 \u01b0\u1edbc \u0111o\u00e1n th\u1eddi gian li\u1ec1n t\u1ef1 nhi\u00ean c\u1ee7a v\u1ebft th\u01b0\u01a1ng theo c\u00f4ng th\u1ee9c allgower:<\/p>\n

T=D:K<\/p>\n

Trong \u0111\u00f3: T: time li\u1ec1n v\u1ebft th\u01b0\u01a1ng(ng\u00e0y)<\/p>\n

D: \u0111\u01b0\u1eddng k\u00ednh v\u1ebft th\u01b0\u01a1ng(mm)<\/p>\n

K: h\u1eb1ng s\u1ed1 =1 or 2<\/p>\n

l N\u1ebfu 2 m\u00e9p v\u1ebft th\u01b0\u01a1ng \u0111\u01b0\u1ee3c kh\u00e2u \u00e1p kh\u00edt v\u00e0o nhau v\u00e0 li\u1ec1n d\u00ednh v\u1edbi r\u1ea5t \u00edt m\u00f4 m\u1edbi t\u1ea1o n\u00ean th\u00ec g\u1ecdi l\u00e0 li\u1ec1n v\u1ebft th\u01b0\u01a1ng k\u1ef3 \u0111\u1ea7u<\/p>\n

N\u1ebfu v\u1ebft th\u01b0\u01a1ng \u0111\u01b0\u1ee3c \u0111\u1ec3 h\u1edf ngay t\u1eeb \u0111\u1ea7u ho\u1eb7c do nhi\u1ec5m tr\u00f9ng m\u00e0 b\u1ecb to\u00e1t l\u1ea1i th\u00ec s\u1ef1 li\u1ec1n v\u1ebft th\u01b0\u01a1ng s\u1ebd tr\u1ea3i qua giai \u0111o\u1ea1n xu\u1ea5t ti\u1ebft v\u00e0 nh\u00ecn th\u1ea5y r\u00f5 s\u1eb9o m\u1edbi h\u00ecnh th\u00e0nh, ta g\u1ecdi l\u00e0 li\u1ec1n v\u1ebft th\u01b0\u01a1ng k\u1ef3 2<\/p>\n

V\u1ebft th\u01b0\u01a1ng li\u1ec1n k\u1ef3 \u0111\u1ea7u s\u1ebd tr\u00e1nh kh\u1ecfi 1 s\u1ed1 di ch\u1ee9ng t\u1ea1i ch\u1ed7 (s\u1eb9o co d\u00fam, l\u00e2u li\u1ec1n, d\u1ec5 lo\u00e9t…) song mu\u1ed1n kh\u00e2u k\u00edn m\u00e0 \u0111\u1ea1t \u0111\u01b0\u1ee3c li\u1ec1n k\u1ef3 \u0111\u1ea7u th\u00ec ph\u1ea3i b\u1ea3o \u0111\u1ea3m c\u1eaft l\u1ecdc \u0111\u00fang quy c\u00e1ch, v\u1ebft th\u01b0\u01a1ng kh\u00e2u k\u00edn kh\u00f4ng c\u0103ng da v\u00e0 kh\u00f4ng b\u1ecb nhi\u1ec5m tr\u00f9ng<\/p>\n

T\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u1ebft th\u01b0\u01a1ng nghi ng\u1ea1i c\u00f3 nhi\u1ec5m tr\u00f9ng ho\u1eb7c kh\u00f4ng c\u00f3 \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n ch\u1ed1ng nhi\u1ec5m tr\u00f9ng ch\u1eafc ch\u1eafn (nh\u01b0 ph\u1ea3i x\u1eed tr\u00ed h\u00e0ng lo\u1ea1t, tai n\u1ea1n bom \u0111\u1ea1n, ph\u01b0\u01a1ng ti\u1ec7n kh\u1eed tr\u00f9ng k\u00e9m….) th\u00ec sau khi c\u1eaft l\u1ecdc n\u00ean \u0111\u1ec3 h\u1edf, khi kh\u00f4ng c\u00f2n nhi\u1ec5m tr\u00f9ng s\u1ebd kh\u00e2u k\u1ef3 2 s\u1edbm<\/p>\n

3. Nh\u1eefng \u0111i\u1ec1u ki\u1ec7n \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 li\u00ean k\u1ebft v\u1ebft th\u01b0\u01a1ng<\/p>\n

C\u00f3 1 s\u1ed1 y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 l\u00e0nh v\u1ebft th\u01b0\u01a1ng v\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a l\u00e0nh v\u1ebft th\u01b0\u01a1ng s\u1edbm<\/p>\n

l B\u1ec7nh nh\u00e2n<\/p>\n

– Ng\u01b0\u1eddi c\u00f3 tu\u1ed5i (>60 tu\u1ed5i)<\/p>\n

– Ng\u01b0\u1eddi c\u00f3 \u0111\u01b0\u1eddng huy\u1ebft cao<\/p>\n

– Ng\u01b0\u1eddi c\u00f3 ure huy\u1ebft cao<\/p>\n

l T\u00e1c nh\u00e2n h\u00f3a h\u1ecdc v\u00e0 ph\u00f3ng x\u1ea1<\/p>\n

– Ng\u01b0\u1eddi c\u00f3 d\u00f9ng thu\u1ed1c corticoid v\u00e0 c\u00e1c ch\u1ea5t \u0111\u1ed9c h\u1ea1i t\u1ebf b\u00e0o (nh\u01b0 thu\u1ed1c tr\u1ecb ung th\u01b0), s\u1ebd l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng mi\u1ec5n d\u1ecbch, gi\u1ea3m kh\u1ea3 n\u0103ng c\u1ee7a \u0111\u1ea1i th\u1ef1c b\u00e0o v\u00e0 gi\u1ea3m b\u1edbt s\u1ef1 t\u1ed5ng h\u1ee3p collagen<\/p>\n

– Ng\u01b0\u1eddi \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1ec7nh b\u1eb1ng tia ph\u00f3ng x\u1ea1, s\u1ef1 b\u1ee9c x\u1ea1 t\u1ecfa ra l\u00e0m cho t\u1ebf b\u00e0o b\u1ecb ho\u1ea1i t\u1eed, t\u1ea1o cho v\u1ebft th\u01b0\u01a1ng l\u00e2u l\u00e0nh<\/p>\n

l T\u00e1c nh\u00e2n quan tr\u1ecdng nh\u1ea5t l\u00e0 gi\u1ea3m \u00e1p l\u1ef1c oxy trong t\u1ed5 ch\u1ee9c m\u00f4. N\u00f3 l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a vi\u1ec7c gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u k\u00e9o d\u00e0i do ch\u1ea5n th\u01b0\u01a1ng, do ch\u00e8n \u00e9p khoang, do thi\u1ebfu l\u01b0\u1ee3ng oxy h\u00edt v\u00e0o ho\u1eb7c nh\u1eefng l\u00fd do kh\u00e1c nh\u01b0 m\u00f4 b\u1ecb ph\u00f9 n\u1ec1 do truy\u1ec1n d\u1ecbch…<\/p>\n

Thi\u1ebfu oxy \u1ea3nh h\u01b0\u1edfng l\u1edbn \u0111\u1ebfn ho\u1ea1t \u0111\u1ed9ng c\u1ee7a \u0111\u1ea1i th\u1ef1c b\u00e0o, v\u1ebft th\u01b0\u01a1ng kh\u00f3 tr\u00e1nh kh\u1ecfi nguy c\u01a1 nhi\u1ec5m tr\u00f9ng v\u00e0 l\u00e0nh k\u1ef3 2C\u00e2u 3: Tr\u00ecnh b\u00e0y c\u00e1c giai \u0111o\u1ea1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ecfng?<\/p>\n

I. C\u00e1c giai \u0111o\u1ea1n c\u1ee7a b\u1ecfng :
\n1. Giai \u0111o\u1ea1n 1 (s\u1ed1c b\u1ecfng): K\u00e9o d\u00e0i 1 \u2013 2 ng\u00e0y<\/p>\n

* Nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf: Do \u0111au v\u00e0 do tho\u00e1t m\u1ea5t huy\u1ebft t\u01b0\u01a1ng.<\/p>\n

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

– L\u00e2m s\u00e0ng b\u1eb1ng m\u1ea1ch nhanh, huy\u1ebft \u00e1p gi\u1ea3m.<\/p>\n

– M\u00e1u c\u00f4 \u0111\u1eb7c, bi\u1ec3u hi\u1ec7n b\u1eb1ng k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m m\u00e1u:<\/p>\n

+ H\u1ed3ng c\u1ea7u t\u0103ng 10-15 tri\u1ec7u\/mm3<\/p>\n

+ Hct t\u0103ng<\/p>\n

+ Hb t\u0103ng c\u00f3 khi \u0111\u1ebfn 120%.<\/p>\n

+ B\u1ea1ch c\u1ea7ut\u0103ng 10000-20000\/mm3.<\/p>\n

– \u0110\u00e1i \u00edt, c\u00f3 khi d\u1eabn \u0111\u1ebfn v\u00f4 ni\u1ec7u.<\/p>\n

– R\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1:<\/p>\n

+ Nhi\u1ec5m acid m\u00e1u<\/p>\n

+ d\u1ef1 tr\u1eef ki\u1ec1m gi\u1ea3m.<\/p>\n

+ Gi\u1ea3m albumin m\u00e1u, protein m\u00e1u th\u1ea5p.<\/p>\n

2. Giai \u0111o\u1ea1n 2 (nhi\u1ec5m \u0111\u1ed9c huy\u1ebft c\u1ea5p): X\u1ea3y ra v\u00e0 k\u00e9o d\u00e0i t\u1eeb ng\u00e0y 4-12<\/p>\n

* Nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf:<\/p>\n

– H\u1ea5p th\u1ee5 c\u00e1c ch\u1ea5t \u0111\u1ed9c ph\u00f3ng th\u00edch ra t\u1eeb t\u1ed5 ch\u1ee9c b\u1ecb hu\u1ef9 ho\u1ea1i.<\/p>\n

– Do \u0111\u1ed9c t\u1ed1 c\u1ee7a vi tr\u00f9ng.<\/p>\n

– H\u1eadu qu\u1ea3 c\u1ee7a r\u1ed1i lo\u1ea1n b\u1ec7nh l\u00fd \u1edf gan, th\u1eadn<\/p>\n

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

– S\u1ed1t cao, m\u1ea1ch nhanh,<\/p>\n

– Th\u1ea7n kinh k\u00edch th\u00edch hay \u1ee9c ch\u1ebf bi\u1ec3u hi\u1ec7n m\u1ea5t ng\u1ee7, n\u00f3i nh\u1ea3m, k\u00e9m \u0103n.<\/p>\n

3. Giai \u0111o\u1ea1n 3 ( nhi\u1ec5m tr\u00f9ng nhi\u1ec5m \u0111\u1ed9c ): Ng\u00e0y 12 tr\u1edf \u0111i<\/p>\n

* C\u01a1 ch\u1ebf:Nhi\u1ec5m tr\u00f9ng m\u1ee7 \u1edf v\u1ebft b\u1ecfng,l\u00e0m nhi\u1ec5m \u0111\u1ed9c t\u1ed1 c\u1ee7a vi tr\u00f9ng, nhi\u1ec5m \u0111\u1ed9c c\u00e1c ch\u1ea5t ho\u1ea1i t\u1eed v\u00e0 b\u1ea9n.<\/p>\n

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

– S\u1ed1t cao dao \u0111\u1ed9ng k\u00e9o d\u00e0i, suy ki\u1ec7t.<\/p>\n

– C\u00f3 th\u1ec3 c\u00f3 bi\u1ebfn ch\u1ee9ng :vi\u00eam ph\u1ed5i, vi\u00eam th\u1eadn, ch\u1ea3y m\u00e1u ti\u00eau ho\u00e1, suy gan<\/p>\n

4. Giao \u0111o\u1ea1n 4 (ph\u1ee5c h\u1ed3i):bi\u1ec3u hi\u1ec7n<\/p>\n

– C\u00e1c ch\u1ed7 b\u1ecfng l\u00e0nh s\u1eb9o<\/p>\n

– C\u00e1c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u1ee7a c\u01a1 quan n\u1ed9i t\u1ea1ng h\u1ed3i ph\u1ee5c d\u1ea7n<\/p>\n

II. \u0110i\u1ec1u tr\u1ecb :<\/p>\n

1. C\u1ea5p c\u1ee9u b\u1ec7nh nh\u00e2n \u1edf tuy\u1ebfn tr\u01b0\u1edbc: 4 nguy\u00ean t\u1eafc<\/p>\n

– Th\u1ee7 ti\u00eau nguy\u00ean nh\u00e2n g\u00e2y b\u1ecfng, trung h\u00f2a hay v\u00f4 hi\u1ec7u h\u00f3a c\u00e1c ch\u1ea5t g\u00e2y b\u1ecfng (h\u00f3a ch\u1ea5t)<\/p>\n

– Tr\u00e1nh g\u00e2y \u0111au \u0111\u1edbn ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng th\u00eam.<\/p>\n

– B\u0103ng b\u1ea3o v\u1ec7 d\u1ef1 ph\u00f2ng nhi\u1ec5m tr\u00f9ng.<\/p>\n

– Ph\u00f2ng v\u00e0 ch\u1ed1ng s\u1ed1c b\u1ecfng<\/p>\n

C\u1ee5 th\u1ec3 l\u00e0:<\/p>\n

– C\u1ee9u n\u1ea1n nh\u00e2n kh\u1ecfi \u0111\u00e1m ch\u00e1y, d\u1eadp t\u1eaft qu\u1ea7n \u00e1o \u0111ang ch\u00e1y, \u0111\u1eafp n\u01b0\u1edbc ho\u1eb7c r\u1eeda nhi\u1ec1u n\u01b0\u1edbc \u0111\u1ed1i v\u1edbi b\u1ecfng do h\u00f3a ch\u1ea5t<\/p>\n

– B\u0103ng v\u00f4 tr\u00f9ng v\u1ebft b\u1ecfng<\/p>\n

– N\u1ebfu b\u1ecfng nhi\u1ec1u n\u00ean b\u1ecdc b\u1ec7nh nh\u00e2n b\u1eb1ng v\u1ea3i s\u1ea1ch, tr\u00e1nh v\u1ee1 c\u00e1c n\u1ed1t ph\u1ed3ng n\u01b0\u1edbc<\/p>\n

– U\u1ed1ng n\u01b0\u1edbc tr\u00e0 \u0111\u01b0\u1eddng<\/p>\n

– Truy\u1ec1n d\u1ecbch<\/p>\n

2. C\u1ea5p c\u1ee9u \u1edf y t\u1ebf huy\u1ec7n: truy\u1ec1n d\u1ecbch<\/p>\n

– Kh\u00e1ng sinh<\/p>\n

– Ti\u00eam ph\u00f2ng u\u1ed1n v\u00e1n<\/p>\n

– Ti\u00eam thu\u1ed1c gi\u1ea3m \u0111au<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb th\u1ef1c th\u1ee5 \u1edf tuy\u1ebfn sau<\/p>\n

3.1. \u0110i\u1ec1u tr\u1ecb s\u1ed1c b\u1ecfng:n\u1ebfu b\u1ecfng n\u1eb7ng c\u00f3 s\u1ed1c ph\u1ea3i \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c<\/p>\n

+ L\u00e0m ngay c\u00e1c x\u00e9t nghi\u1ec7m:H\u1ed3ng c\u1ea7u, Hct, b\u1ea1ch c\u1ea7u, Hb; \u0111o \u00e1p l\u1ef1c TM trung t\u00e2m (CVP): \u0110\u1eb7t 1 \u1ed1ng th\u00f4ng v\u00e0o b\u00e0ng quang \u0111\u1ec3 theo d\u00f5i l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u\/gi\u1edd, c\u00e2n n\u1eb7ng b\u1ec7nh nh\u00e2n, theo d\u00f5i DHST<\/p>\n

+ Ch\u1ed1ng \u0111au \u0111\u1edbn:<\/p>\n

Morphin 0,01g ti\u00eam d\u01b0\u1edbi da hay ti\u00eam b\u1eafp<\/p>\n

Cho h\u1ed7n h\u1ee3p: dolargan 0,1g; pipolphen 0,025g; atropin 1\/4mg; n\u01b0\u1edbc c\u1ea5t v\u1eeba \u0111\u1ee7 10ml.<\/p>\n

Ti\u00eam chia 2-3 l\u1ea7n, ti\u00eam TM hay ti\u00eam b\u1eafp, m\u1ed7i l\u1ea7n 1ml<\/p>\n

+ Truy\u1ec1n d\u1ecbch theo c\u00f4ng th\u1ee9c Evan-Brooke<\/p>\n

C\u00f4ng th\u1ee9c Evan-Brooke:<\/p>\n

0,5ml x % di\u1ec7n t\u00edch x c\u00e2n n\u1eb7ng = dung d\u1ecbch keo (Plasma. Dextran hay m\u00e1u)<\/p>\n

1,5ml x % di\u1ec7n t\u00edch x c\u00e2n n\u1eb7ng = dung d\u1ecbch \u0111i\u1ec7n gi\u1ea3i g\u1ed3m NaCl 9\u2030, Lactat Ringer<\/p>\n

C\u1ed9ng v\u1edbi 2000ml dung d\u1ecbch glucose 5%.<\/p>\n

* Ng\u00e0y \u0111\u1ea7u: 8h \u0111\u1ea7u: \u00bd kh\u1ed1i l\u01b0\u1ee3ng d\u1ecbch truy\u1ec1n.<\/p>\n

16h sau: \u00bd kh\u1ed1i l\u01b0\u1ee3ng d\u1ecbch truy\u1ec1n.<\/p>\n

* Ng\u00e0y th\u1ee9 2: Cho truy\u1ec1n b\u1eb1ng \u00bd hay \u00be kh\u1ed1i l\u01b0\u1ee3ng ng\u00e0y \u0111\u1ea7u.<\/p>\n

* Ch\u00fa \u00fd: N\u1ebfu b\u1ecfng tr\u00ean 50% v\u1eabn t\u00ednh di\u1ec7n t\u00edch nh\u01b0 50%.<\/p>\n

3.2.\u0110i\u1ec1u tr\u1ecb b\u1ecfng nh\u1eb9:ch\u1ee7 y\u1ebfu \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 b\u1ecfng b\u1eb1ng<\/p>\n

– Thu\u1ed1c gi\u1ea3m \u0111au<\/p>\n

– R\u1eeda, b\u0103ng v\u00f4 tr\u00f9ng v\u1ebft b\u1ecfng.<\/p>\n

– Thu\u1ed1c kh\u00e1ng sinh.<\/p>\n

– Ti\u00eam ph\u00f2ng u\u1ed1n v\u00e1n.<\/p>\n

– Sinh t\u1ed1.<\/p>\n

3.3.\u0110i\u1ec1u tr\u1ecb ti\u1ebfp t\u1ee5c:<\/p>\n

– Ch\u1ed1ng nhi\u1ec5m tr\u00f9ng b\u1eb1ng thu\u1ed1c kh\u00e1ng sinh<\/p>\n

– Sinh t\u1ed1<\/p>\n

– Ch\u0103m s\u00f3c v\u1ebft b\u1ecfng: thay b\u0103ng,c\u1eaft l\u1ecdc ho\u1ea1i t\u1eed, gh\u00e9p da s\u1edbm l\u00e0 bi\u1ec7n ph\u00e1p t\u00edch c\u1ef1c trong ch\u1eefa b\u1ecfng hi\u1ec7n \u0111\u1ea1i. R\u1eeda-b\u0103ng v\u00f4 tr\u00f9ng<\/p>\n

– Nu\u00f4i d\u01b0\u1ee1ng ch\u0103m s\u00f3c: chi\u1ebfm vai tr\u00f2 r\u1ea5t quan tr\u1ecdng, \u0103n kh\u1ea9u ph\u1ea7n c\u00f3 \u0111\u1ea7y \u0111\u1ee7 ch\u1ea5t b\u1ed5 v\u00e0 gi\u00e0u n\u0103ng l\u01b0\u1ee3ng 3000-4000calo, nhi\u1ec1u \u0111\u1ea1m, nhi\u1ec1u vitamin v\u00e0 d\u1ec5 h\u1ea5p th\u1ee5<\/p>\n

– C\u00f4ng t\u00e1c \u0111i\u1ec1u d\u01b0\u1ee1ng c\u1ea7n ph\u1ea3i ch\u00fa \u00fd: ng\u1eeba bi\u1ebfn ch\u1ee9ng h\u1eb9p hay d\u00ednh cho b\u1ecfng \u1ee1 nh\u1eefng v\u00f9ng v\u1eadn \u0111\u1ed9ng nh\u01b0 kh\u1edbp (khu\u1ef7u, g\u1ed1i, b\u00e0n tay…) v\u00e0 c\u00e1c l\u1ed7 t\u1ef1 nhi\u00ean ( m\u0169i, m\u1eaft, h\u1eadu m\u00f4n)<\/p>\n

C\u00e2u 16:ph\u00e2n loai b\u1ecfng theo chi\u1ec1u s\u00e2u v\u00e0 di\u1ec7n t\u00edch ?<\/p>\n

1. Ph\u00e2n lo\u1ea1i theo \u0111\u1ed9 s\u00e2u:<\/p>\n

– \u0110\u1ed9 I: C\u00f2n g\u1ecdi l\u00e0 b\u1ecfng th\u01b0\u1ee3ng b\u00ec: da \u0111\u1ecf, \u0111au r\u00e1t<\/p>\n

– \u0110\u1ed9 II: B\u1ecfng l\u1edbp bi\u1ec3u b\u00ec. N\u1ed1t ph\u1ed3ng n\u01b0\u1edbc tr\u00ean n\u1ec1n da \u0111\u1ecf, s\u1edd v\u00e0o n\u1ec1n \u0111\u1ecf r\u1ea5t \u0111au. Huy\u1ebft t\u01b0\u01a1ng t\u00e1ch l\u1edbp \u0111\u00e1y v\u00e0 l\u1edbp gai ra<\/p>\n

– \u0110\u1ed9 III: Chia l\u00e0m 2 m\u1ee9c \u0111\u1ed9<\/p>\n

+ IIIa: t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng ho\u00e0n to\u00e0n l\u1edbp da, t\u1ed5n th\u01b0\u01a1ng bi\u1ec3u b\u00ec to\u00e0n b\u1ed9, 1 ph\u1ea7n trung b\u00ec c\u00f2n s\u00f3t l\u1ea1i c\u00e1c \u0111\u00e1m t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 tuy\u1ebfn v\u00e0 \u0111\u00e1y l\u00f4ng bi\u1ec3u hi\u1ec7n n\u1ed1t ph\u1ed3ng n\u01b0\u1edbc, \u0111\u00e1y n\u1ed1t ph\u1ed3ng tr\u1eafng b\u1ec7ch, s\u1edd v\u00e0o kh\u00f4ng \u0111au ho\u1eb7c \u0111au \u00edt<\/p>\n

+ III b: Ho\u1ea1i t\u1eed to\u00e0n b\u1ed9 l\u1edbp da, da x\u00e1m t\u00e1i nh\u1ee3t nh\u1ea1t m\u00e0u \u0111\u00e1 c\u1ea9m th\u1ea1ch, m\u1ea5t c\u1ea3m gi\u00e1c.<\/p>\n

– \u0110\u1ed9 IV:ho\u1ea1i t\u1eed da v\u00e0 c\u00e2n c\u01a1 d\u01b0\u1edbi da, c\u00f3 khi \u0111\u1ebfn x\u01b0\u01a1ngd\u01b0\u1edbi 2 h\u00ecnh th\u00e1i l\u00e0 ho\u1ea1i t\u1eed \u01b0\u1edbt v\u00e0 ho\u1ea1i t\u1eed kh\u00f4<\/p>\n

.Ho\u1ea1i t\u1eed kh\u00f4: ch\u1eafc, kh\u00f4, \u0111en ho\u1eb7c v\u00e0ng s\u1eabm, l\u00f5m h\u01a1n da l\u00e0nh<\/p>\n

. Ho\u1ea1i t\u1eed \u01b0\u1edbt: m\u00e0u tr\u1eafng b\u1ec7ch \u0111\u1ecf x\u00e1m, nh\u01b0 \u0111\u00e1 hoa, tro x\u00e1m. Tan r\u1eefa v\u00e0 r\u1ee5ng t\u1eeb ng\u00e0y 15-20<\/p>\n

M\u1ea5t to\u00e0n b\u1ed9 c\u1ea3m gi\u00e1c, th\u1ea5y r\u00f5 c\u00e1c \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi da b\u1ecb \u0111\u00f4ng t\u1eafc<\/p>\n

2. Ph\u00e2n lo\u1ea1i theo di\u1ec7n t\u00edch:<\/p>\n

* L\u00ea Th\u1ebf Trung<\/p>\n

– 1%: Gan b\u00e0n tay, Mu b\u00e0n tay, M\u1eb7t tr\u01b0\u1edbc c\u1ed5, B\u1ed9 ph\u1eadn sinh d\u1ee5c ngo\u00e0i, T\u1ea7ng sinh m\u00f4n<\/p>\n

– 3%: M\u1eb7t, \u0111\u1ea7u (ph\u1ea7n c\u00f3 t\u00f3c), C\u1eb3ng tay, c\u00e1ch tay, B\u00e0n ch\u00e2n<\/p>\n

– 18%: B\u1ee5ng-ng\u1ef1c, L\u01b0ng, 2 m\u00f4ng, M\u1ed9t chi d\u01b0\u1edbi<\/p>\n

* Quy lu\u1eadt s\u1ed1 9 ( Wallace): \u01af\u1edbc l\u01b0\u1ee3ng gan b\u00e0n tay l\u00e0 1%: – \u0110\u1ea7u m\u1eb7t c\u1ed5 9%<\/p>\n

– M\u1ed9t chi tr\u00ean 9%<\/p>\n

– M\u1ed9t chi d\u01b0\u1edbi 18%<\/p>\n

– V\u00f9ng sinh d\u1ee5c ngo\u00e0i : 1%<\/p>\n

– Th\u00e2n m\u1eb7t tr\u01b0\u1edbc ho\u1eb7c th\u00e2n m\u1eb7t sau: 18%<\/p>\n

C\u00e2u 17:Tr\u00ecnh b\u00e0y c\u00e1c nguy\u00ean nh\u00e2n v\u00e0 ph\u00e2n lo\u1ea1i b\u1ecfng theo quy lu\u1eadt s\u1ed1 9(Wallace)<\/p>\n

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

B\u1ed1n t\u00e1c nh\u00e2n ch\u00ednh : s\u1ee9c n\u00f3ng , \u0111i\u1ec7n , b\u1ee9c x\u1ea1 , h\u00f3a ch\u1ea5t
\n1. B\u1ecfng do s\u1ee9c n\u00f3ng: hay g\u1eb7p nh\u1ea5t chi\u1ebfm 84\u00ae 93% chia l\u00e0m 2 nh\u00f3m<\/p>\n

+ B\u1ecfng do s\u1ee9c n\u00f3ng kh\u00f4: Nh\u01b0 do l\u1eeda ch\u00e1y, nhi\u1ec7t \u0111\u1ed9 c\u00f3 khi r\u1ea5t cao nh\u01b0 ch\u00e1y kh\u00ed axetylen l\u00ean \u0111\u1ebfn 2127 \u0111\u1ed9 C. N\u1ebfu b\u1ecfng do ch\u00e1y nh\u00e0, ch\u00e1y kho ch\u1ee9a, ng\u01b0\u1eddi b\u1ecb b\u1ecfng c\u00f3 th\u1ec3 b\u1ecb nhi\u1ec5m \u0111\u1ed9c c\u00e1c kh\u00ed nh\u01b0 Co, NH3, acid nitric. B\u1ecfng do c\u00e1c v\u1eadt n\u00f3ng ch\u1ea3y nh\u01b0 kim lo\u1ea1i n\u00f3ng ch\u1ea3y trong luy\u1ec7n kim g\u00e2y n\u00ean b\u1ecfng<\/p>\n

+ B\u1ecfng do s\u1ee9c n\u00f3ng \u01b0\u1edbt: Nhi\u1ec7t \u0111\u1ed9 g\u00e2y b\u1ecfng th\u01b0\u1eddng kh\u00f4ng cao nh\u01b0 n\u01b0\u1edbc s\u00f4i, d\u1ea7u m\u1ee1. Tuy nhi\u1ec7t \u0111\u1ed9 kh\u00f4ng cao nh\u01b0ng s\u1ee9c n\u00f3ng k\u00e9o d\u00e0i l\u00ean da n\u00ean s\u1ee9c n\u00f3ng \u01b0\u1edbt c\u0169ng g\u00e2y b\u1ecfng s\u00e2u. B\u1ecfng do c\u00e1c n\u1ed3i h\u1ea5p, n\u1ed3i s\u00fap de th\u01b0\u1eddng g\u00e2y b\u1ecfng c\u1ea3 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/p>\n

2. B\u1ecfng do lu\u1ed3ng \u0111i\u1ec7n: M\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng do \u0111i\u1ec7n l\u1ef1c, \u0111i\u1ec7n th\u1ebf, \u0111i\u1ec3m v\u00e0o v\u00e0 ra c\u1ee7a lu\u1ed3ng \u0111i\u1ec7n, \u0111i\u1ec7n tr\u1edf c\u1ee7a m\u00f4 t\u1ed5 ch\u1ee9c, th\u1eddi gian b\u1ecb, khu v\u1ef1c c\u01a1 th\u1ec3 ch\u1ecbu \u1ea3nh h\u01b0\u1edfng c\u1ee7a lu\u1ed3ng \u0111i\u1ec7n d\u1eabn truy\u1ec1n. T\u1ed5n th\u01b0\u01a1ng t\u1ea1i ch\u1ed5 c\u1ee7a b\u1ecfng \u0111i\u1ec7n th\u01b0\u1eddng b\u1ecb b\u1ecfng s\u00e2u (t\u1edbi c\u01a1, x\u01b0\u01a1ng\u2026) T\u1ed5n th\u01b0\u01a1ng to\u00e0n th\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0: cho\u00e1ng \u0111i\u1ec7n, ng\u1eebng tim, ng\u1eebng h\u00f4 h\u1ea5p. B\u1ecfng \u0111i\u1ec7n c\u00f3 th\u1ec3 do lu\u1ed3ng \u0111i\u1ec7n c\u00f3 hi\u1ec7u \u0111i\u1ec7n th\u1ebf th\u00f4ng th\u01b0\u1eddng(<1000V) ho\u1eb7c do lu\u1ed3ng \u0111i\u1ec7n c\u00f3 hi\u1ec7u \u0111i\u1ec7n th\u1ebf cao (>1000V), s\u00e9t \u0111\u00e1nh c\u0169ng l\u00e0 1 lo\u1ea1i b\u1ecfng \u0111i\u1ec7n.<\/p>\n

3. B\u1ecfng do h\u00f3a ch\u1ea5t:<\/p>\n

Bao g\u1ed3m c\u00e1c ch\u1ea5t oxy ho\u00e1 (KMnO4\u2026), ch\u1ea5t kh\u1eed oxy (HCl, HNO3\u2026), ch\u1ea5t g\u1eb7m m\u00f2n (phenolphosphor\u2026), ch\u1ea5t ki\u1ec1m m\u1ea1nh (KOH, NaOH\u2026).<\/p>\n

T\u1ed5n th\u01b0\u01a1ng b\u1ecfng do h\u00f3a ch\u1ea5t ph\u1ee5 thu\u1ed9c v\u00e0o lo\u1ea1i h\u00f3a ch\u1ea5t, n\u1ed3ng \u0111\u1ed9 ch\u1ea5t \u0111\u00f3 v\u00e0 th\u1eddi gian h\u00f3a ch\u1ea5t l\u01b0u l\u1ea1i tr\u00ean da v\u00e0 ni\u00eam m\u1ea1c. B\u1ecfng do h\u00f3a ch\u1ea5t th\u01b0\u1eddng g\u1eb7p: b\u1ecfng da, b\u1ecfng m\u1eaft, b\u1ecfng th\u1ef1c qu\u1ea3n….Phosphor tr\u1eafng ngo\u00e0i g\u00e2y ch\u00e1y c\u00f2n \u0111\u1ed9c<\/p>\n

4. B\u1ecfng b\u1ee9c x\u1ea1<\/p>\n

G\u1ed3m nhi\u1ec1u lo\u1ea1i nh\u01b0 tia h\u1ed3ng ngo\u1ea1i, t\u1eed ngo\u1ea1i, lade, tia gamma.<\/p>\n

T\u1ed5n th\u01b0\u01a1ng b\u1ecfng ph\u1ee5 thu\u1ed9c v\u00e0o lo\u1ea1i tia, m\u1eadt \u0111\u1ed9 ch\u00f9m tia, kho\u1ea3ng c\u00e1ch t\u1eeb ngu\u1ed3n tia \u0111\u1ebfn da, th\u1eddi gian t\u00e1c d\u1ee5ng. B\u1ecfng n\u1eafng c\u0169ng l\u00e0 1 lo\u1ea1i b\u1ecfng do b\u1ee9c x\u1ea1 \u00e1nh s\u00e1ng g\u00e2y ra.<\/p>\n

C\u00e2u 4: Tr\u00ecnh b\u00e0y c\u00e1c giai \u0111o\u1ea1n c\u1ee7a m\u00ea?<\/p>\n

I. Giai \u0111o\u1ea1n I : (qu\u00ean & gi\u1ea3m \u0111au) : T\u1eeb l\u00fac b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng thu\u1ed1c m\u00ea t\u1edbi l\u00fac m\u1ea5t \u00fd th\u1ee9c – h\u01a1i th\u1edf y\u00ean t\u0129nh, tuy nhi\u00ean \u0111\u00f4i khi kh\u00f4ng \u0111\u1ec1u, & c\u00e1c ph\u1ea3n x\u1ea1 v\u1eabn c\u00f2n hi\u1ec7n di\u1ec7n.<\/p>\n

II. Giai \u0111o\u1ea1n II: (m\u00ea s\u1ea3ng ho\u1eb7c k\u00edch th\u00edch): T\u1eeb l\u00fac m\u1ea5t \u00fd th\u1ee9c cho \u0111\u1ebfn l\u00fac m\u00ea ho\u00e0n to\u00e0n<\/p>\n

Trong giai \u0111o\u1ea1n n\u00e0y BN c\u00f3 th\u1ec3 c\u1eed \u0111\u1ed9ng ch\u00e2n tay, n\u00f3i huy\u00ean thuy\u00ean kh\u00f4ng m\u1ea1ch l\u1ea1c, n\u00edn th\u1edf, ho\u1eb7c tr\u1edf n\u00ean qu\u00e1 kh\u00edch, n\u00f4n m\u1eeda r\u1ea5t nguy hi\u1ec3m do h\u00edt v\u00e0o ch\u1ea5t n\u00f4n. Tr\u00e1nh g\u00e2y k\u00edch th\u00edch \u1edf giai \u0111o\u1ea1n n\u00e0y; c\u1ea7n nhanh ch\u00f3ng \u0111\u01b0a BN qua giai \u0111o\u1ea1n III.<\/p>\n

III. Giai \u0111o\u1ea1n III: (m\u00ea ph\u1eabu thu\u1eadt): B\u1eaft \u0111\u1ea7u t\u1eeb khi th\u1edf \u0111\u1ec1u (m\u1ed9t c\u00e1ch c\u00e2n \u0111\u1ed1i) & m\u1ea5t ho\u00e0n to\u00e0n tri gi\u00e1c cho \u0111\u1ebfn khi c\u00f3 d\u1ea5u hi\u1ec7u \u0111\u1ea7u ti\u00ean c\u1ee7a suy h\u00f4 h\u1ea5p & tu\u1ea7n ho\u00e0n – giai \u0111o\u1ea1n n\u00e0y \u0111\u01b0\u1ee3c chia ra b\u1ed1n m\u1ee9c \u0111\u1ed9:<\/p>\n

1. M\u1ee9c \u0111\u1ed9 1: – M\u1ea5t t\u1ea5t c\u1ea3 nh\u1eefng c\u1eed \u0111\u1ed9ng & h\u00edt th\u1edf tr\u1edf n\u00ean c\u00e2n \u0111\u1ed1i (nh\u01b0 m\u00e1y).<\/p>\n

– M\u1ea5t ph\u1ea3n x\u1ea1 mi m\u1eaft, nh\u01b0ng nh\u00e3n c\u1ea7u c\u00f2n ho\u1ea1t \u0111\u1ed9ng r\u00f5.<\/p>\n

– Ph\u1ea3n x\u1ea1 h\u1ecdng h\u1ea7u m\u1ea5t, nh\u01b0ng ph\u1ea3n x\u1ea1 thanh qu\u1ea3n & ph\u00fac m\u1ea1c v\u1eabn c\u00f2n, tr\u01b0\u01a1ng l\u1ef1c c\u01a1 b\u1ee5ng c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 th\u00f4ng qua tr\u01b0\u01a1ng l\u1ef1c c\u1ee7a c\u01a1 ngo\u1ea1i nh\u00e3n c\u1ea7u.<\/p>\n

2. M\u1ee9c \u0111\u1ed9 2: – Nh\u00e3n c\u1ea7u c\u1ed1 \u0111\u1ecbnh ch\u00ednh gi\u1eefa, k\u1ebft m\u1ea1c m\u1ea5t s\u00e1ng (\u0111\u1ee5c),<\/p>\n

– C\u01a1 li\u00ean s\u01b0\u1eddn gi\u1ea3m b\u1edbt h\u0111. H\u01a1i th\u1edf v\u1eabn c\u00f2n c\u00e2n \u0111\u1ed1i, dung t\u00edch l\u01b0u th\u00f4ng (tidal) gi\u1ea3m b\u1edbt, v\u00e0 kh\u00f4ng thay \u0111\u1ed5i nh\u1ecbp ho\u1eb7c bi\u00ean \u0111\u1ed9 khi r\u1ea1ch da. \u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n kh\u00f4ng c\u00f2n g\u00e2y ra co th\u1eaft thanh qu\u1ea3n.<\/p>\n

3. M\u1ee9c \u0111\u1ed9 3: – Xu\u1ea5t hi\u1ec7n li\u1ec7t c\u01a1 li\u00ean s\u01b0\u1eddn, ch\u1ec9 c\u00f2n h\u00f4 h\u1ea5p b\u1eb1ng c\u01a1 ho\u00e0nh.<\/p>\n

– \u0110\u1ed3ng t\u1eed kh\u00f4ng ph\u1ea3n \u1ee9ng v\u1edbi \u00e1nh s\u00e1ng n\u1eefa, & to\u00e0n b\u1ed9 c\u00e1c c\u01a1 gi\u00e3n ho\u00e0n to\u00e0n.<\/p>\n

4. M\u1ee9c \u0111\u1ed9 4: M\u00ea s\u00e2u ho\u00e0n to\u00e0n, ng\u1eebng t\u1ef1 th\u1edf & m\u1ea5t c\u1ea3m gi\u00e1c.<\/p>\n

IV. Giai \u0111o\u1ea1n IV: (g\u1ea7n ch\u1ebft) v\u1edbi nhi\u1ec1u d\u1ea5u hi\u1ec7u nguy hi\u1ec3mnh\u01b0 :<\/p>\n

– \u0110\u1ed3ng t\u1eed gi\u00e3n r\u1ed9ng t\u1ed1i \u0111a<\/p>\n

– Da l\u1ea1nh v\u1edbi m\u00e0u x\u00e1m tro<\/p>\n

– Huy\u1ebft \u00e1p t\u1ee5t th\u01b0\u1eddng kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c, m\u1ea1ch quay r\u1ea5t y\u1ebfu ho\u1eb7c kh\u00f4ng b\u1eaft \u0111\u01b0\u1ee3c. Ng\u1eebng tim s\u1eafp x\u1ea3y ra – c\u1ea7n gi\u1ea3m b\u1edbt thu\u1ed1c m\u00ea ngay, th\u00f4ng kh\u00ed ph\u1ed5i b\u1eb1ng tay v\u1edbi 100% oxy, & thay kh\u00ed li\u00ean t\u1ee5c trong b\u00f3ng b\u00f3p (li\u00ean t\u1ee5c l\u00e0m r\u1ed7ng b\u00f3ng)…<\/p>\n

C\u00e2u 18: Bi\u1ebfn ch\u1ee9ng c\u1ee7a g\u00e2y t\u00ea<\/p>\n

I. Ph\u1ea3n \u1ee9ng th\u01b0\u1eddng g\u1eb7p<\/p>\n

1. Bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh trung \u01b0\u01a1ng<\/p>\n

2. Th\u00ecnh l\u00ecnh, co gi\u1eadt, l\u01a1 m\u01a1 ho\u1eb7c h\u00f4n m\u00ea<\/p>\n

3. Bi\u1ebfn ch\u1ee9ng h\u00f4 h\u1ea5p<\/p>\n

4. Ng\u01b0ng th\u1edf: thu\u1ed1c t\u00ea b\u00e1m v\u00e0o d\u00e2y th\u1ea7n kinh<\/p>\n

5. Bi\u1ebfn ch\u1ee9ng tu\u1ea7n ho\u00e0n<\/p>\n

6. Tr\u1ee5y m\u1ea1ch, tr\u1ee5y tim<\/p>\n

II. Ng\u0103n ng\u1eeba tai bi\u1ebfn:<\/p>\n

– D\u00f9ng l\u01b0\u1ee3ng thu\u1ed1c \u00edt nh\u1ea5t m\u00e0 \u0111\u1ee7 \u0111\u1ea1t y\u00eau c\u1ea7u t\u1ed1t nh\u1ea5t<\/p>\n

– C\u00f9ng 1 l\u01b0\u1ee3ng thu\u1ed1c t\u00ea, ti\u00eam nhi\u1ec1u l\u1ea7n nguy h\u1ea1i h\u01a1n 1 l\u1ea7n<\/p>\n

– Ti\u00eam t\u1eeb t\u1eeb,\u0111\u1ec1 ph\u00f2ng ti\u00eam v\u00e0o m\u1ea1ch m\u00e1u<\/p>\n

– D\u00f9ng c\u1ea9n th\u1eadn Epinephrin<\/p>\n

C\u00e2u 38: Tr\u00ecnh b\u00e0y c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a g\u00e2y m\u00ea?<\/p>\n

I. C\u00e1c bi\u1ebfn ch\u1ee9ng trong th\u1eddi k\u1ef3 ti\u1ec1n m\u00ea:<\/p>\n

– Ti\u1ec1n m\u00ea nh\u1eb1m m\u1ee5c \u0111\u00edch gi\u00fap b\u1ec7nh nh\u00e2n y\u00ean t\u0129nh, gi\u1ea3m ho\u1eb7c m\u1ea5t lo l\u1eafng, s\u1ee3 h\u00e3i, g\u00e2y ng\u1ee7, g\u00e2y qu\u00ean, gi\u1ea3m \u0111au v\u00e0 gi\u1ea3m ti\u1ebft d\u1ecbch, gi\u1ea3m \u0111\u01b0\u1ee3c li\u1ec1u l\u01b0\u1ee3ng thu\u1ed1c m\u00ea, thu\u1ed1c gi\u00e3n c\u01a1, \u0111\u1ec1 ph\u00f2ng c\u00e1c bi\u1ebfn ch\u1ee9ng do d\u1ecb \u1ee9ng v\u00e0 h\u1ed9i ch\u1ee9ng Mendelson. Tuy nhi\u00ean b\u00ean c\u1ea1nh \u0111\u00f3 \u1edf giai \u0111o\u1ea1n n\u00e0y c\u0169ng c\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ebfn ch\u1ee9ng ch\u1ee7 y\u1ebfu l\u00e0 do c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c nh\u1ea5t l\u00e0 h\u1ecd Morphin nh\u01b0 suy h\u00f4 h\u1ea5p, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n, t\u0103ng ti\u1ebft Histamin, c\u00f3 th\u1ec3 g\u00e2y t\u1ee5t huy\u1ebft \u00e1p n\u1ebfu gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n.<\/p>\n

– \u0110\u1ec1 ph\u00f2ng c\u1ea7n theo d\u00f5i s\u00e1t c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ti\u1ec1n m\u00ea, kh\u00f4ng bao gi\u1edd \u0111\u1ec3 b\u1ec7nh nh\u00e2n \u0111\u00e3 ti\u1ec1n m\u00ea \u1edf m\u1ed9t m\u00ecnh, b\u1ed3i ph\u1ee5 th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu h\u1ee5t tr\u01b0\u1edbc khi ti\u1ec1n m\u00ea.<\/p>\n

II. C\u00e1c bi\u1ebfn ch\u1ee9ng trong th\u1eddi k\u1ef3 kh\u1edfi m\u00ea:<\/p>\n

-Tai bi\u1ebfn do \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n<\/p>\n

-Co th\u1eaft thanh-kh\u00ed-ph\u1ebf qu\u1ea3n<\/p>\n

-N\u00f4n, tr\u00e0o ng\u01b0\u1ee3c<\/p>\n

-H\u1ea1 huy\u1ebft \u00e1p, tr\u1ee5y tim m\u1ea1ch<\/p>\n

-T\u0103ng huy\u1ebft \u00e1p<\/p>\n

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

-Nh\u1ecbp ch\u1eadm xoang<\/p>\n

-Nh\u1ecbp nhanh xoang<\/p>\n

-Ngo\u1ea1i t\u00e2m thu<\/p>\n

-Sai l\u1ec7ch v\u1ecb tr\u00ed c\u1ee7a \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n<\/p>\n

-T\u0103ng CO2 m\u00e1u (\u01b0u th\u00e1n)<\/p>\n

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

-Co th\u1eaft ph\u1ebf qu\u1ea3n<\/p>\n

-C\u00e1c bi\u1ebfn ch\u1ee9ng v\u1ec1 tu\u1ea7n ho\u00e0n<\/p>\n

III. C\u00e1c bi\u1ebfn ch\u1ee9ng trong th\u1eddi k\u1ef3 tho\u00e1t m\u00ea:<\/p>\n

-Suy h\u00f4 h\u1ea5p<\/p>\n

-Co th\u1eaft thanh kh\u00ed ph\u1ebf qu\u1ea3n<\/p>\n

-T\u0103ng huy\u1ebft \u00e1p v\u00e0 m\u1ea1ch nhanh<\/p>\n

-X\u1eb9p ph\u1ed5i<\/p>\n

-T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean<\/p>\n

-Ph\u00f9 thanh m\u00f4n c\u1ea5p<\/p>\n

C\u00e2u 43: Tr\u00ecnh b\u00e0y ph\u01b0\u01a1ng ph\u00e1p ti\u1ec7t khu\u1ea9n b\u1eb1ng bi\u1ec7n ph\u00e1p h\u00f3a h\u1ecdc?<\/p>\n

1. H\u00ecnh th\u1ee9c ti\u1ec7t khu\u1ea9n b\u1eb1ng c\u00e1ch d\u00f9ng c\u00e1c ch\u1ea5t h\u00f3a h\u1ecdc c\u00f3 t\u00e1c d\u1ee5ng di\u1ec7t khu\u1ea9n ho\u1eb7c k\u00ecm khu\u1ea9n, h\u00ecnh th\u1ee9c ti\u1ec7t khu\u1ea9n n\u00e0y \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng r\u1ed9ng r\u00e3i cho c\u1ea3 con ng\u01b0\u1eddi v\u00e0 v\u1eadt d\u1ee5ng, m\u00f4i tr\u01b0\u1eddng.<\/p>\n

2. H\u00f3a ch\u1ea5t ti\u1ec7t khu\u1ea9n:<\/p>\n

– \u1ede ng\u01b0\u1eddi \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ch\u1ea5t s\u00e1t tr\u00f9ng ho\u1eb7c thu\u1ed1c kh\u00e1ng sinh. Ch\u1ea5t s\u00e1t tr\u00f9ng l\u00e0 thu\u1ed1c d\u00f9ng \u0111\u1ec3 ti\u1ec7t tr\u00f9ng cho ngo\u00e0i da v\u00e0 v\u1ebft th\u01b0\u01a1ng, thu\u1ed1c kh\u00e1ng sinh l\u00e0 thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng ti\u1ec7t tr\u00f9ng nh\u01b0ng c\u00f3 th\u1ec3 \u0111\u01b0a \u0111\u01b0\u1ee3c v\u00e0o trong c\u01a1 th\u1ec3 con ng\u01b0\u1eddi qua \u0111\u01b0\u1eddng ti\u00eam ch\u00edch ho\u1eb7c \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n

– D\u00f9ng cho v\u1eadt d\u1ee5ng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ch\u1ea5t t\u1ea9y u\u1ebf.<\/p>\n

Khi ch\u1ecdn h\u00f3a ch\u1ea5t ti\u1ec7t khu\u1ea9n d\u00f9ng cho ng\u01b0\u1eddi ph\u1ea3i \u0111\u1ea3m b\u1ea3o hai y\u00eau c\u1ea7u: thu\u1ed1c kh\u00f4ng g\u00e2y h\u1ea1i ho\u1eb7c \u00edt g\u00e2y h\u1ea1i cho t\u1ea1i ch\u1ed7 ho\u1eb7c to\u00e0n th\u00e2n, thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng di\u1ec7t vi khu\u1ea9n t\u1ed1t.<\/p>\n

3. T\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c ph\u01b0\u01a1ng th\u1ee9c ti\u1ec7t khu\u1ea9n: t\u00f9y thu\u1ed9c v\u00e0o c\u1ea5u tr\u00fac h\u00f3a h\u1ecdc v\u00e0 \u0111\u1eb7c t\u00ednh l\u00fd h\u00f3a c\u1ee7a t\u1eebng ch\u1ea5t. Nh\u1eefng c\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng c\u0103n b\u1ea3n c\u1ee7a c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ti\u1ec7t khu\u1ea9n b\u1eb1ng ho\u00e1 h\u1ecdc hi\u1ec7n \u0111ang s\u1eed d\u1ee5ng l\u00e0 oxy h\u00f3a, \u0111\u00f4ng albumin, l\u00e0m v\u1ee1 m\u00e0ng hay v\u00e1ch c\u1ee7a vi khu\u1ea9n, chi\u1ebfm ch\u1ed7 t\u00e1c d\u1ee5ng c\u1ee7a m\u1ed9t s\u1ed1 ch\u1ea5t quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a c\u1ee7a vi khu\u1ea9n… H\u1eadu qu\u1ea3 cu\u1ed1i c\u00f9ng l\u00e0 l\u00e0m ch\u1ebft vi khu\u1ea9n (t\u00e1c d\u1ee5ng di\u1ec7t khu\u1ea9n) ho\u1eb7c k\u00ecm h\u00e3m s\u1ef1 ph\u00e1t tri\u1ec3n v\u00e0 sinh s\u1ea3n c\u1ee7a vi khu\u1ea9n (t\u00e1c d\u1ee5ng k\u00ecm khu\u1ea9n).<\/p>\n

*M\u1ed9t s\u1ed1 ch\u1ea5t s\u00e1t tr\u00f9ng th\u00f4ng d\u1ee5ng:<\/p>\n

Nh\u00f3m Halogen:<\/p>\n

– Cloramin B c\u00f3 t\u00e1c d\u1ee5ng di\u1ec7t khu\u1ea9n v\u00e0 m\u1ea5t m\u00f9i.Trong y h\u1ecdc th\u01b0\u1eddng d\u00f9ng:<\/p>\n

+ dung d\u1ecbch 0.5% d\u00f9ng \u0111\u1ec3 ng\u00e2m tay<\/p>\n

+ dung d\u1ecbch 1%-2% \u0111\u1ec3 r\u1eeda v\u1ebft th\u01b0\u01a1ng<\/p>\n

+ c\u00f3 th\u1ec3 d\u00f9ng dung d\u1ecbch 2% \u0111\u1ec3 ti\u1ec7t khu\u1ea9n c\u00e1c v\u1eadt d\u1ee5ng kh\u00f4ng ph\u1ea3i l\u00e0 kim lo\u1ea1i<\/p>\n

– C\u00e1c h\u1ee3p ch\u1ea5t c\u00f3 iod: c\u1ed3n iod l\u00e0 lo\u1ea1i th\u00f4ng d\u1ee5ng nh\u1ea5t hi\u1ec7n nay d\u00f9ng \u0111\u1ec3 kh\u1eed khu\u1ea9n v\u00f9ng m\u1ed5, m\u00e9p v\u1ebft th\u01b0\u01a1ng… C\u00f3 t\u00e1c d\u1ee5ng di\u1ec7t khu\u1ea9n m\u1ea1nh nh\u01b0ng m\u1ed9t s\u1ed1 ng\u01b0\u1eddi c\u00f3 th\u1ec3 b\u1ecb p.\u1ee9ng vi\u00eam da do d\u1ecb \u1ee9ng v\u1edbi iod.<\/p>\n

Nh\u00f3m oxy h\u00f3a:<\/p>\n

– Dung d\u1ecbch oxy gi\u00e0 ch\u1ee9a 3% H2O2 trong n\u01b0\u1edbc, l\u00e0 dung d\u1ecbch ti\u1ec7t khu\u1ea9n nh\u1eb9 nh\u01b0ng t\u1ea1o \u0111i\u1ec1u ki\u1ec7n kh\u00f4ng thu\u1eadn l\u1ee3i cho s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a VK k\u1ef5 kh\u00ed v\u00e0 VK ho\u1ea1i th\u01b0 sinh h\u01a1i. Ngo\u00e0i ra, dung d\u1ecbch oxy gi\u00e0 c\u00f2n s\u1ee7i b\u1ecdt m\u1ea1nh khi cho v\u00e0o v\u1ebft th\u01b0\u01a1ng n\u00ean c\u00f2n c\u00f3 t\u00e1c d\u1ee5ng \u0111\u1ea9y ra ngo\u00e0i nh\u1eefng ch\u1ea5t ho\u1ea1i t\u1eed, m\u00e1u c\u1ee5c v\u00e0 m\u1ee7…<\/p>\n

– Thu\u1ed1c t\u00edm: dung d\u1ecbch ch\u1ee9a KMnO4, c\u00f3 t\u00e1c d\u1ee5ng oxy h\u00f3a v\u00e0 l\u00e0m m\u1ea5t m\u00f9i.<\/p>\n

+ Dung d\u1ecbch 0.05%-0.1% \u0111\u1ec3 r\u1eeda v\u1ebft th\u01b0\u01a1ng<\/p>\n

+ dung d\u1ecbch 0.01%-0.1% d\u00f9ng \u0111\u1ec3 s\u00fac mi\u1ec7ng v\u00e0 h\u1ecdng<\/p>\n

+ dung d\u1ecbch 2%-5% d\u00f9ng \u0111\u1ec3 b\u00f4i c\u00e1c v\u1ebft lo\u00e9t do t\u00e1c d\u1ee5ng l\u00e0m s\u0103n da c\u1ee7a n\u00f3.<\/p>\n

Nh\u00f3m c\u00f3 mu\u1ed1i kim lo\u1ea1i n\u1eb7ng:<\/p>\n

– Lo\u1ea1i c\u00f3 th\u1ee7y ng\u00e2n: d\u00f9ng \u0111\u1ec3 s\u00e1t khu\u1ea9n v\u00f9ng m\u1ed5 v\u00e0 b\u00f4i l\u00ean c\u00e1c v\u1ebft th\u01b0\u01a1ng n\u00f4ng, di\u1ec7n h\u1eb9p.<\/p>\n

– Lo\u1ea1i c\u00f3 ch\u1ee9a b\u1ea1c: nitrat b\u1ea1c v\u1edbi n\u1ed3ng \u0111\u1ed9 th\u1ea5p 1%-2% c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m s\u0103n da v\u00e0 ch\u1ed1ng vi\u00eam. V\u1edbi \u0111\u1eadm \u0111\u1ed9 cao 5%-10% c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m ch\u00e1y c\u00e1c m\u00f4. Dung d\u1ecbch nitrat b\u1ea1c c\u00f3 t\u00ednh ti\u1ec7t khu\u1ea9n m\u1ea1nh.<\/p>\n

Nh\u00f3m c\u1ed3n:<\/p>\n

– C\u1ed3n etylic \u1edf th\u1ecb tr\u01b0\u1eddng th\u01b0\u1eddng d\u00f9ng d\u01b0\u1edbi hai lo\u1ea1i c\u1ed3n 700 c\u00f3 t\u00e1c d\u1ee5ng s\u00e1t khu\u1ea9n v\u00e0 c\u1ed3n 900 c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m s\u0103n c\u1ee9ng.<\/p>\n

– C\u1ed3n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong y khoa \u0111\u00e3 h\u00e0ng ch\u1ee5c n\u0103m nay \u0111\u1ec3 ti\u1ec7t khu\u1ea9n v\u00e0 l\u00e0m s\u0103n da v\u1ebft m\u1ed5, tay ph\u1eabu thu\u1eadt vi\u00ean, ngo\u00e0i ra n\u00f3 c\u00f2n \u0111\u01b0\u1ee3c d\u00f9ng ti\u1ec7t khu\u1ea9n c\u1ea3 d\u1ee5ng c\u1ee5.<\/p>\n

Nh\u00f3m Aldehyd:<\/p>\n

– Formon hay Formandehyd l\u00e0 dung d\u1ecbch r\u1ea5t \u0111\u1ed9c d\u00f9ng \u0111\u1ec3 ti\u1ec7t khu\u1ea9n d\u1ee5ng c\u1ee5, gants, \u1ed1ng d\u1eabn l\u01b0u v\u00e0 c\u1ed1 \u0111\u1ecbnh c\u00e1c m\u1eabu sinh thi\u1ebft r\u1ea5t t\u1ed1t.<\/p>\n

– Phenol: dung d\u1ecbch 2%-3% c\u0169ng \u0111\u1ec3 d\u00f9ng ti\u1ec7t khu\u1ea9n d\u1ee5ng c\u1ee5, gants, \u1ed1ng d\u1eabn l\u01b0u. V\u1edbi n\u1ed3ng cao c\u00f3 th\u1ec3 g\u00e2y b\u1ecfng da v\u00e0 ni\u00eam m\u1ea1c.<\/p>\n

Nh\u00f3m c\u00f3 ch\u1ee9a ch\u1ea5t m\u00e0u:xanh methylen c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng ti\u1ec7t khu\u1ea9n v\u00e0 l\u00e0m s\u0103n da, \u0111\u01b0\u1ee3c d\u00f9ng cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p b\u1ecb vi\u00eam da c\u00f3 m\u1ee7 ho\u1eb7c d\u00f9ng l\u00e0m dung d\u1ecbch r\u1eeda \u0111\u01b0\u1eddng ni\u1ec7u…<\/p>\n

C\u00e2u 5: Tr\u00ecnh b\u00e0y c\u00e1ch ph\u00e2n lo\u1ea1i vi\u00eam ph\u00fac m\u1ea1c<\/p>\n

C\u00f3 nhi\u1ec1u c\u00e1ch \u0111\u1ec3 ph\u00e2n bi\u1ec7t.<\/p>\n

A. PH\u00c2N LO\u1ea0I THEO NGUY\u00caN NH\u00c2N<\/p>\n

1. Vi\u00eam ph\u00fac m\u1ea1c ti\u00ean ph\u00e1t: l\u00e0 lo\u1ea1i nhi\u1ec5m tr\u00f9ng tr\u1ef1c ti\u1ebfp c\u1ee7a ph\u00fac m\u1ea1c t\u1eeb\u0111\u01b0\u1eddng m\u00e1u, \u0111\u01b0\u1eddng b\u1ea1ch m\u1ea1ch do li\u00ean c\u1ea7u khu\u1ea9n, ph\u1ebf c\u1ea7u khu\u1ea9n, tr\u1ef1c khu\u1ea9n lao.<\/p>\n

2. Vi\u00eam ph\u00fac m\u1ea1c th\u1ee9 ph\u00e1t:<\/p>\n

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

– Th\u1ee7ng hay v\u1ee1 \u0111\u01b0\u1eddng ti\u00eau ho\u00e1: hay g\u1eb7p nh\u1ea5t l\u00e0 th\u1ee7ng \u1ed5 lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng ho\u1eb7cl\u00e0 do ho\u1ea1i t\u1eed ru\u1ed9t hay th\u1ee7ng h\u1ed3i tr\u00e0ng trong b\u1ec7nh th\u01b0\u01a1ng h\u00e0n.<\/p>\n

– Th\u1ee7ng \u0111\u01b0\u1eddng m\u1eadt do vi\u00eam t\u00fai m\u1eadt ho\u1ea1i t\u1eed, th\u1ee7ng \u1ed1ng m\u1eadt ch\u1ee7 trong nhi\u1ec5mtr\u00f9ng \u0111\u01b0\u1eddng m\u1eadt do s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7<\/p>\n

– V\u1ee1 m\u1ed9t \u1ed5 \u00e1p xe, m\u1ed9t b\u1ecdc m\u1ee7, m\u1ed9t \u1ed5 nhi\u1ec5m tr\u00f9ng trong xoang b\u1ee5ng nh\u01b0 vi\u00eamph\u00fac m\u1ea1c do vi\u00eam ru\u1ed9t th\u1eeba v\u1ee1 m\u1ee7, vi\u00eam m\u1ee7 v\u00f2i tr\u1ee9ng, \u00e1p xe tai v\u00f2i, \u00e1p xe gan, \u00e1p xed\u01b0\u1edbi ho\u00e0nh v. v…<\/p>\n

b) Ch\u1ea5n th\u01b0\u01a1ng hay v\u1ebft th\u01b0\u01a1ng b\u1ee5ng<\/p>\n

– Ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng (do ng\u00e3 cao,do t\u00e9 xe,do v\u1eadt c\u1ee9ng \u0111\u1eadp v\u00e0o)c\u00f3 th\u1ec3 l\u00e0m v\u1ee1ru\u1ed9t non, v\u1ee1 b\u00e0ng quang …<\/p>\n

– V\u1ebft th\u01b0\u01a1ng b\u1ee5ng (do m\u1ea3nh bom, m\u1ea3nh \u0111\u1ea1n, v\u1eadt nh\u1ecdn s\u1eafc) c\u00f3 th\u1ec3 l\u00e0m th\u1ee7ng b\u1ea5tc\u1ee9 t\u1ea1ng n\u00e0o tr\u00ean \u0111\u01b0\u1eddng \u0111i c\u1ee7a t\u00e1c nh\u00e2n g\u00e2y v\u1ebft th\u01b0\u01a1ng.<\/p>\n

c) Ph\u1eabu thu\u1eadt<\/p>\n

– M\u1ecdi \u0111\u01b0\u1eddng kh\u00e2u, mi\u1ec7ng n\u1ed1i \u1edf \u0111\u01b0\u1eddng ti\u00eau ho\u00e1, \u1edf \u0111\u01b0\u1eddng m\u1eadt, trong tu\u1ea7n l\u1ec5\u0111\u1ea7u sau m\u1ed5 \u0111\u1ec1u c\u00f3 \u00edt nhi\u1ec1u kh\u1ea3 n\u0103ng b\u1ee5c ch\u1ec9, d\u1ecbch ti\u00eau ho\u00e1 hay d\u1ecbch m\u1eadt theo ch\u1ed7 h\u1edftr\u00e0n v\u00e0o xoang b\u1ee5ng g\u00e2y vi\u00eam ph\u00fac m\u1ea1c.<\/p>\n

– VPM c\u00f2n c\u00f3 th\u1ec3 do s\u00f3t m\u1ee7 trong xoang b\u1ee5ng m\u00e0 trong l\u1ea7n m\u1ed5 tr\u01b0\u1edbc l\u1ea5y kh\u00f4ngh\u1ebft hay do nhi\u1ec5m tr\u00f9ng xoang b\u1ee5ng v\u00ec kh\u00f4ng tu\u00e2n th\u1ee7 tri\u1ec7t \u0111\u1ec3 c\u00e1c kh\u00e2u v\u00f4 tr\u00f9ng trongph\u1eabu thu\u1eadt .<\/p>\n

B. PH\u00c2N LO\u1ea0I THEO M\u1ee8C \u0110\u1ed8 LAN TR\u00c0N C\u1ee6A TH\u01af\u01a0NG T\u1ed4N.<\/p>\n

1. VPM to\u00e0n th\u1ec3<\/p>\n

G\u1ecdi l\u00e0 VPM to\u00e0n th\u1ec3 khi m\u1ee7 v\u00e0 d\u1ecbch b\u1ea9n lan tr\u00e0n kh\u1eafp c\u1ea3 b\u1ee5ng tr\u00ean l\u1eabn b\u1ee5ngd\u01b0\u1edbi (c\u0169ng c\u00f3 th\u1ec3 m\u1ee7 v\u00e0 d\u1ecbch b\u1ea9n nhi\u1ec1u \u1edf b\u1ee5ng d\u01b0\u1edbi , \u00edt \u1edf b\u1ee5ng tr\u00ean).<\/p>\n

2. VPM khu tr\u00fa<\/p>\n

G\u1ecdi l\u00e0 VPM khu tr\u00fa khi m\u1ee7 ch\u1ec9 c\u00f3 \u1edf m\u1ed9t v\u00f9ng n\u00e0o \u0111\u00f3 c\u1ee7a xoang b\u1ee5ng. M\u1ee7 khutr\u00fa \u1edf h\u1ed1 ch\u1eadu ph\u1ea3i khi ru\u1ed9t th\u1eeba vi\u00eam m\u1ee7 v\u1ee1 hay khu tr\u00fa \u1edf ti\u1ec3u khung khi vi\u00eam m\u1ee7 v\u00f2itr\u1ee9ng v\u1ee1… VPM khu tr\u00fa c\u00f3 th\u1ec3 tr\u1edf th\u00e0nh VPM to\u00e0n th\u1ec3 khi m\u1ee7 t\u1eeb m\u1ed9t n\u01a1i lan tr\u00e0nsang v\u00f9ng kh\u00e1c c\u1ee7a xoang b\u1ee5ng.<\/p>\n

\u00c1p xe d\u01b0\u1edbi ho\u00e0nh, \u00e1p xe h\u1eadu cung m\u1ea1c n\u1ed1i, \u00e1p xe t\u00fai c\u00f9ng Douglas l\u00e0 m\u1ed9t lo\u1ea1iVPM khu tr\u00fa nh\u01b0ng \u1edf \u0111\u00e2y \u1ed5 m\u1ee7 \u0111\u01b0\u1ee3c bao b\u1ecdc b\u1edfi m\u1ed9t v\u00e1ch d\u1ea7y ng\u0103n c\u00e1ch r\u00f5 r\u1ec7t v\u1edbichung quanh.<\/p>\n

C. PH\u00c2N LO\u1ea0I THEO DI\u1ec4N BI\u1ebeN<\/p>\n

1. VPM c\u1ea5p t\u00ednh: L\u00e0 lo\u1ea1i c\u00f3 di\u1ec5n bi\u1ebfn nhanh ch\u00f3ng, h\u00e0ng gi\u1edd hay h\u00e0ng ng\u00e0y.n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c kh\u1ea9n tr\u01b0\u01a1ng \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u, b\u1ec7nh nh\u00e2n s\u1ebd ch\u1ebft trong v\u00f2ng 4-5 ng\u00e0ytrong t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng nhi\u1ec5m \u0111\u1ed9c.<\/p>\n

2. VPM m\u1ea1n t\u00ednh: C\u00f3 di\u1ec5n bi\u1ebfn nhi\u1ec1u th\u00e1ng c\u00f3 khi nhi\u1ec1u n\u0103m. V\u00ed d\u1ee5 VPM dolao (lao ph\u00fac m\u1ea1c)<\/p>\n

D. PH\u00c2N LO\u1ea0I THEO T\u00c1C NH\u00c2N G\u00c2Y B\u1ec6NH<\/p>\n

1. VPM do vi khu\u1ea9n<\/p>\n

– Vi khu\u1ea9n g\u00e2y VPM ti\u00ean ph\u00e1t th\u01b0\u1eddng g\u1eb7p l\u00e0 li\u00ean c\u1ea7u khu\u1ea9n, ph\u1ebf c\u1ea7u khu\u1ea9n, tr\u1ef1ckhu\u1ea9n lao.<\/p>\n

– Vi khu\u1ea9n g\u1eb7p trong VPM th\u1ee9 ph\u00e1t l\u00e0 c\u00e1c vi khu\u1ea9n \u0111\u01b0\u1eddng ru\u1ed9t nh\u01b0 tr\u1ef1c tr\u00e0ngColi, proteus,Pseudomonas, Kleb – siella v. v… v\u00e0 c\u00e1c vi khu\u1ea9n k\u1ef5 kh\u00ed.<\/p>\n

2. VPM ho\u00e1 h\u1ecdc<\/p>\n

Th\u01b0\u1eddng g\u1eb7p l\u00e0 VPM do th\u1ee7ng \u1ed5 lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng trong giai \u0111o\u1ea1n s\u1edbm. Trongnh\u1eefng gi\u1edd \u0111\u1ea7u sau khi th\u1ee7ng, d\u1ecbch trong xoang b\u1ee5ng kh\u00f4ng c\u00f3 vi khu\u1ea9n, l\u00fac n\u00e0y ph\u00facm\u1ea1c b\u1ecb k\u00edch th\u00edch b\u1edfi acid chlorhydric c\u00f3 nhi\u1ec1u trong d\u1ecbch v\u1ecb. Sau 6-12 gi\u1edd VPM ho\u00e1h\u1ecdc s\u1ebd tr\u1edf th\u00e0nh VPM nhi\u1ec5m tr\u00f9ng.Vi\u00eam t\u1ee5y c\u1ea5p c\u0169ng l\u00e0 m\u1ed9t lo\u1ea1i VPM ho\u00e1 h\u1ecdc.C\u00e2u 6: Tr\u00ecnh b\u00e0y c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng vi\u00eam ph\u00fac m\u1ea1c<\/p>\n

A. L\u00c2M S\u00c0NG<\/p>\n

VPM c\u00f3 nhi\u1ec1u lo\u1ea1i, m\u1ed7i lo\u1ea1i c\u00f3 m\u1ed9t b\u1ec7nh c\u1ea3nhl\u00e2m s\u00e0ng kh\u00e1c nhau. VPM ti\u00ean ph\u00e1t \u00edt g\u1eb7p, th\u01b0\u1eddng g\u1eb7p trong l\u00e2m s\u00e0ng h\u00e0ng ng\u00e0y l\u00e0VPM th\u1ee9 ph\u00e1t. H\u1ed9i ch\u1ee9ng VPM bao g\u1ed3m c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a lo\u1ea1i VPM to\u00e0n th\u1ec3 c\u1ea5pt\u00ednh sau \u0111\u00e2y:<\/p>\n

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

1. \u0110au b\u1ee5ng.<\/p>\n

\u0110au b\u1ee5ng l\u00e0 tri\u1ec7u ch\u1ee9ng bao g\u1ed3m, c\u0169ng c\u00f3 khi l\u00e0 l\u00fd do \u0111\u01b0a b\u1ec7nh nh\u00e2n t\u1edbi b\u1ec7nhvi\u1ec7n.<\/p>\n

\u0110au kh\u1eafp to\u00e0n th\u1ec3 b\u1ee5ng nh\u01b0ng h\u1ecfi k\u1ef9 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 cho bi\u1ebft n\u01a1i \u0111au nhi\u1ec1unh\u1ea5t. V\u1ecb tr\u00ed \u0111au l\u00fac b\u1ec7nh kh\u1edfi \u0111\u1ea7u v\u00e0 n\u01a1i \u0111au nhi\u1ec1u nh\u1ea5t hi\u1ec7n t\u1ea1i gi\u00fap ch\u1ea9n \u0111o\u00e1nnguy\u00ean nh\u00e2n c\u1ee7a VPM. Vd: \u1edf h\u1ed1 ch\u1eadu ph\u1ea3i ngh\u0129 \u0111\u1ebfn nguy\u00ean nh\u00e2n vi\u00eam ru\u1ed9t th\u1eeba, \u1edfm\u1ea1ng s\u1eddn v\u00e0 d\u01b0\u1edbi m\u1ea1ng s\u01b0\u1eddn ph\u1ea3i ngh\u0129 \u0111\u1ebfn b\u1ec7nh l\u00fd c\u1ee7a gan v\u00e0 \u0111\u01b0\u1eddng d\u1eabn m\u1eadt.<\/p>\n

\u0110au TN0, \u0111au nhi\u1ec1u v\u00e0 \u0111au li\u00ean t\u1ee5c. M\u1ed7i khi c\u1eed \u0111\u1ed9ng t\u0103ng l\u00ean n\u00ean BN n\u1eb1m im kh\u00f4ng d\u00e1m c\u1eed \u0111\u1ed9ng kh\u00f4ng d\u00e1m ho m\u1ea1nh, kh\u00f4ng d\u00e1m th\u1edf s\u00e2u. Khi xoay tr\u1edfng\u01b0\u1eddi, khi di chuy\u1ec3n ph\u1ea3i r\u1ea5t t\u1eeb t\u1eeb, nh\u1eb9 nh\u00e0ng.<\/p>\n

T\u00ednh ch\u1ea5t \u0111au gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c \u1edf b\u1ee5ng. t\u1eafc ru\u1ed9t \u0111aut\u1eebng c\u01a1n r\u00f5 r\u1ec7t, s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7 \u0111au l\u0103n l\u1ed9n, k\u00eau la v. v…<\/p>\n

2. N\u00f4n \u00f3i<\/p>\n

N\u00f4n \u00f3i l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng c\u00f3 trong VPM. Trong VPM n\u00f4n kh\u00f4ng nhi\u1ec1u, l\u00fac\u0111\u1ea7u n\u00f4n khan, n\u00f4n do ph\u00fac m\u1ea1c b\u1ecb k\u00edch th\u00edch. V\u1ec1 sau, khi b\u1ec7nh nh\u00e2n \u0111\u1ebfn tr\u1ec5, ru\u1ed9tkh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng co b\u00f3p v\u00ec n\u1eb1m trong m\u1ed9t xoang b\u1ee5ng \u0111\u1ea7y m\u1ee7 v\u00e0 d\u1ecbch b\u1ea9n, d\u1ecbchtrong l\u00f2ng ru\u1ed9t \u1ee9 \u0111\u1ecdng l\u1ea1i nhi\u1ec1u, l\u00fac \u0111\u00f3 b\u1ec7nh nh\u00e2n c\u0169ng n\u00f4n nhi\u1ec1u. V\u00ec v\u1eady trongnhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 ch\u1ea9n \u0111o\u00e1n l\u1ea7m m\u1ed9t VPM v\u1edbi m\u1ed9t t\u1eafc ru\u1ed9t.<\/p>\n

3. B\u00ed trung v\u00e0 \u0111\u1ea1i ti\u1ec7n<\/p>\n

B\u00ed trung v\u00e0 \u0111\u1ea1i ti\u1ec7n c\u0169ng th\u01b0\u1eddng g\u1eb7p nh\u01b0 n\u00f4n \u00f3i, th\u01b0\u1eddng bao gi\u1edd c\u0169ng c\u00f3 trong VPM, nh\u1ea5t l\u00e0 VPM \u0111\u1ebfn tr\u1ec5.<\/p>\n

B\u00ed trung ti\u1ec7n trong VPM kh\u00f4ng ho\u00e0n to\u00e0n v\u00e0 kh\u00f4ng r\u00f5 r\u1ec7t nh\u01b0 trong t\u1eafc ru\u1ed9t c\u01a1h\u1ecdc. C\u00f3 th\u1ec3 th\u1ec9nh tho\u1ea3ng b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n c\u00f3 trung ti\u1ec7n nh\u01b0ng ch\u1ec9 ch\u00fat \u00edt v\u00e0 y\u1ebfu \u1edbt.<\/p>\n

Trong t\u1eafc ru\u1ed9t sau khi c\u00f3 trung ti\u1ec7n th\u00ec c\u00e1c r\u1ed1i lo\u1ea1n \u0111\u01b0\u1ee3c thu x\u1ebfp, b\u1ec7nh nh\u00e2n tr\u1edf l\u1ea1itr\u1ea1ng th\u00e1i b\u00ecnh th\u01b0\u1eddng hay g\u1ea7n b\u00ecnh th\u01b0\u1eddng.<\/p>\n

Trong VPM, sau khi c\u00f3 trung ti\u1ec7n b\u1ec7nhnh\u00e2n c\u1ea3m th\u1ea5y d\u1ec5 ch\u1ecbu, \u0111\u1ee1 \u0111au \u0111\u00f4i ch\u00fat, r\u1ed3i ch\u1ec9 nhi\u1ec1u ph\u00fat sau l\u1ea1i \u0111au tr\u1edf l\u1ea1i nh\u01b0 c\u0169.<\/p>\n

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

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

Th\u01b0\u1eddng th\u1ea5y b\u1ee5ng tr\u01b0\u1edbng, m\u1ee9c \u0111\u1ed9 tr\u01b0\u1edbng \u00edt hay nhi\u1ec1u l\u00e0 tu\u1ef3 thu\u1ed9c v\u00e0o th\u1eddi gian\u0111\u1ebfn b\u1ec7nh vi\u1ec7n c\u1ee7a b\u1ec7nh nh\u00e2n, l\u00fac m\u1edbi \u0111\u1ea7u b\u1ee5ng tr\u01b0\u1edbng \u00edt nh\u01b0ng sau v\u00e0i ng\u00e0y b\u1ee5ngtr\u01b0\u1edbng nhi\u1ec1u c\u00f3 khi tr\u01b0\u1edbng c\u0103ng. Tr\u01b0\u1edbng b\u1ee5ng l\u00e0m b\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf, nh\u1ea5t l\u00e0 \u1edf tr\u1ebbem, th\u00e0nh b\u1ee5ng m\u1ecfng n\u00ean nhi\u1ec1u khi th\u1ea5y r\u00f5 quai r\u00f5 n\u1ed5i tr\u00ean th\u00e0nh b\u1ee5ng. B\u1ee5ng tr\u01b0\u1edbngl\u00e0 v\u00ec c\u00e1c quai ru\u1ed9t non b\u1ecb gi\u00e3n to do li\u1ec7t.<\/p>\n

\u0110au b\u1ee5ng, n\u00f4n \u00f3i, b\u00ed trung \u0111\u1ea1i ti\u1ec7n, tr\u01b0\u1edbng b\u1ee5ng c\u0169ng l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u1eafcru\u1ed9t c\u01a1 h\u1ecdc, v\u00ec v\u1eady nhi\u1ec1u l\u1ea7n r\u1ea5t kh\u00f3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t m\u1ed9t VPM v\u1edbi m\u1ed9t t\u1eafc ru\u1ed9tc\u01a1 h\u1ecdc. Trong VPM bao gi\u1edd c\u0169ng c\u00f3 t\u1eafc ru\u1ed9t nh\u01b0ng t\u1eafc ru\u1ed9t trong VPM l\u00e0 t\u1eafc ru\u1ed9t c\u01a1n\u0103ng do ru\u1ed9t b\u1ecb li\u1ec7t.<\/p>\n

\u1ede nh\u1eefng thanh ni\u00ean kho\u1ebb m\u1ea1nh, khi th\u1ee7ng d\u1ea1 d\u00e0y th\u1ea5y b\u1ee5ng ph\u1eb3ng, n\u1eb1m imkh\u00f4ng di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf (b\u1ee5ng kh\u00f4ng th\u1edf), c\u00e1c th\u1edb c\u01a1 n\u1ed5i r\u00f5.<\/p>\n

2. S\u1edd n\u1eafn:<\/p>\n

Hai tri\u1ec7u ch\u1ee9ng bao gi\u1edd c\u0169ng c\u00f3 trong VPM l\u00e0:- Co c\u1ee9ng th\u00e0nh b\u1ee5ng<\/p>\n

– C\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c<\/p>\n

M\u1ee9c \u0111\u1ed9 th\u1ec3 hi\u1ec7n c\u1ee7a hai tri\u1ec7u ch\u1ee9ng n\u00e0y thay \u0111\u1ed5i tu\u1ef3 theo nguy\u00ean nh\u00e2n c\u1ee7aVPM, tu\u1ef3 theo b\u1ec7nh nh\u00e2n \u0111\u1ebfn s\u1edbm hay mu\u1ed9n, tu\u1ef3 theo gi\u00e0 hay tr\u1ebb, tu\u1ef3 theo nam hayn\u1eef, tu\u1ef3 theo b\u00e9o m\u1eadp c\u00f3 th\u00e0nh b\u1ee5ng d\u00e0y hay g\u1ea7y \u1ed1m c\u00f3 th\u00e0nh b\u1ee5ng m\u1ecfng.<\/p>\n

a) Co c\u1ee9ng th\u00e0nh b\u1ee5ng<\/p>\n

\u0110\u1ec3 b\u1ec7nh nh\u00e2n trong t\u01b0 th\u1ebf tho\u1ea3i m\u00e1i nh\u1ea5t: n\u1eb1m ng\u1eeda, g\u1ed1i cao, 2 ch\u00e2n co, 2 b\u00e0nch\u00e2n \u0111\u1eb7t tr\u00ean m\u1eb7t gi\u01b0\u1eddng, 2 tay xu\u00f4i s\u00e1t th\u00e2n m\u00ecnh. \u0110\u1ec3 l\u1ed9 ho\u00e0n to\u00e0n v\u00f9ng b\u1ee5ng, \u00e1ok\u00e9o tr\u00ean v\u00fa, qu\u1ea7n xu\u1ed1ng qu\u00e1 n\u1ebfp b\u1eb9n, Th\u1ea7y thu\u1ed1c ng\u1ed3i tr\u00ean gh\u1ebf \u0111\u1eb7t b\u00ean ph\u1ea3igi\u01b0\u1eddng b\u1ec7nh nh\u00e2n, v\u1eeba kh\u00e1m v\u1eeba h\u1ecfi chuy\u1ec7n b\u1ec7nhnh\u00e2n.<\/p>\n

H\u1ecfi b\u1ec7nh nh\u00e2n n\u01a1i n\u00e0o \u0111au nhi\u1ec1u nh\u1ea5t, b\u1ea3o b\u1ec7nh nh\u00e2n c\u1ed1 g\u1eafng th\u1edf \u0111\u1ec1u v\u00e0 th\u1edf s\u00e2u\u0111\u1ec3 l\u00e0m cho th\u00e0nh b\u1ee5ng m\u1ec1m.<\/p>\n

B\u1eb1ng c\u1ea3 4 ng\u00f3n tay (2,3,4,5) \u1ea5n nh\u1eb9 nh\u00e0ng tr\u00ean th\u00e0nh b\u1ee5ng b\u1eaft \u0111\u1ea7u t\u1eeb ch\u1ed7 \u0111au \u00edt\u0111i d\u1ea7n sang c\u00e1c v\u00f9ng kh\u00e1c c\u1ee7a th\u00e0nh b\u1ee5ng (th\u01b0\u1eddng l\u00e0 b\u1eaft \u0111\u1ea7u t\u1eeb h\u1ed1 ch\u1eadu tr\u00e1i). M\u1ecdi\u0111\u1ed9ng t\u00e1c th\u00f4 b\u1ea1o, \u0111\u1ed9t ng\u1ed9t, b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c b\u00e1o tr\u01b0\u1edbc s\u1ebd g\u00e2y n\u00ean nh\u1eefng coc\u1ee9ng gi\u1ea3 t\u1ea1o.<\/p>\n

Co c\u1ee9ng th\u00e0nh b\u1ee5ng r\u00f5 nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n th\u1ee7ng d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng \u0111\u1ebfn s\u1edbm trongv\u00f2ng 12 gi\u1edd \u0111\u1ea7u, l\u00fac n\u00e0y ph\u00fac m\u1ea1c b\u1ecb k\u00edch th\u00edch b\u1edfi t\u00ednh acid c\u1ee7a d\u1ecbch, b\u1ee5ng c\u1ee9ng nh\u01b0 g\u1ed7, ngay c\u1ea3 nh\u00ecn c\u0169ng th\u1ea5y.<\/p>\n

Trong nh\u1eefngtr\u01b0\u1eddng h\u1ee3p kh\u00e1c, co c\u1ee9ng th\u00e0nh b\u1ee5ng \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9 h\u01a1n. Tuy v\u1eady th\u01b0\u1eddng c\u0169ng d\u1ec5d\u00e0ng nh\u1eadn bi\u1ebft, s\u1edd n\u1eafn th\u1ea5y \u1edf gi\u1eefa b\u1ee5ng c\u00e1c th\u1edb c\u1ee7a c\u01a1 th\u1eb3ng b\u1ee5ng \u1edf hai b\u00ean l\u00e0 c\u00e1c th\u1edb c\u1ee7a c\u01a1 ch\u00e9o ngo\u00e0i.<\/p>\n

Co c\u1ee9ng bao gi\u1edd c\u0169ng k\u00e8m theo \u0111au khi \u1ea5n. Co c\u1ee9ng th\u00e0nhb\u1ee5ng trong VPM l\u00e0 co c\u1ee9ng th\u1eadt s\u1ef1. Co c\u1ee9ng th\u01b0\u1eddng xuy\u00ean v\u00e0 kh\u00e1ch quan. Khi th\u00e0nh b\u1ee5ng co c\u1ee9ng kh\u00f4ng r\u00f5 th\u00ecph\u1ea3i \u1ea5n r\u1ea5t nh\u1eb9 nh\u00e0ng v\u00e0 so s\u00e1nh hai b\u00ean b\u1ee5ng.<\/p>\n

C\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi ph\u1ea3n \u1ee9ng t\u1ef1 v\u1ec7: l\u00e0khi \u1ea5n nh\u1ef1 nh\u00e0ng t\u1eeb t\u1eeb, t\u1eeb n\u00f4ng v\u00e0o s\u00e2u, l\u00fac \u0111\u1ea7u th\u1ea5y b\u1ee5ng m\u1ec1m nh\u01b0ng \u1ea5n s\u00e2u h\u01a1nn\u1eefa t\u1edbi m\u1ed9t m\u1ee9c n\u00e0o \u0111\u00f3 th\u1ea5y b\u1ec7nh nh\u00e2n k\u00eau \u0111au v\u00e0 th\u00e0nh b\u1ee5ng co c\u1ee9ng l\u1ea1i, ng\u0103n c\u1ea3nkh\u00f4ng cho tay th\u1ea7y thu\u1ed1c ti\u1ebfn s\u00e2u h\u01a1n n\u1eefa v\u00ec \u1ea5n s\u00e2u s\u1ebd l\u00e0m \u0111au t\u0103ng th\u00eam. N\u1ebfu l\u1ea1i s\u1eddn\u1eafn nh\u1eb9 nh\u00e0ng, th\u1ea5y b\u1ee5ng m\u1ec1m tr\u1edf l\u1ea1i.<\/p>\n

Co c\u1ee9ng nhi\u1ec1u \u00edt kh\u00e1c nhau tu\u1ef3 t\u1eebng v\u00f9ng v\u00e0th\u01b0\u1eddng l\u00e0 to\u00e0n th\u1ec3 th\u00e0nh b\u1ee5ng, c\u00f2n ph\u1ea3n \u1ee9ng t\u1ef1 v\u1ec7 th\u01b0\u1eddng ch\u1ec9 c\u00f3 \u1edf m\u1ed9t v\u00f9ng khu tr\u00fan\u00e0o \u0111\u00f3 c\u1ee7a th\u00e0nh b\u1ee5ng.<\/p>\n

Co c\u1ee9ng l\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a m\u1ed9t ph\u00fac m\u1ea1c vi\u00eam. Ph\u1ea3n\u1ee9ng t\u1ef1 v\u1ec7 l\u00e0 bi\u1ec3u hi\u1ec7n m\u1ed9t th\u01b0\u01a1ng t\u1ed5n (th\u01b0\u1eddng l\u00e0 vi\u00eam nhi\u1ec5m) c\u1ee7a m\u1ed9t t\u1ea1ng n\u00e0o \u0111\u00f3trong xoang b\u1ee5ng nh\u01b0 \u1ed5 lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng \u0111ang trong c\u01a1n \u0111au c\u1ea5p t\u00ednh, vi\u00eam t\u00faim\u1eadt, \u00e1p xe gan…<\/p>\n

b) C\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c<\/p>\n

Trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a VPM, tri\u1ec7u ch\u1ee9ng co c\u1ee9ng th\u00e0nh b\u1ee5ng n\u1ed5i b\u1eadt. V\u1ec1 sau,b\u1ee5ng m\u1ed7i l\u00fac m\u1ed9t ch\u01b0\u1edbng, c\u00e1c c\u01a1 th\u00e0nh b\u1ee5ng b\u1edbt co c\u1ee9ng d\u1ea7n v\u00e0 thay v\u00e0o \u0111\u00f3 l\u00e0 tri\u1ec7uch\u1ee9ng c\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c.<\/p>\n

D\u00f9ng \u0111\u1ea7u ng\u00f3n tay \u1ea5n t\u1eeb t\u1eeb nh\u1eb9 nh\u00e0ng tr\u00ean th\u00e0nh b\u1ee5ng, \u0111\u1ebfn m\u1ed9t m\u1ee9c n\u00e0o \u0111\u00f3 (l\u00facph\u00fac m\u1ea1c th\u00e0nh b\u1ee5ng tr\u01b0\u1edbc b\u1ecb \u0111\u1ee5ng ch\u1ea1m) b\u1ec7nh nh\u00e2n \u0111au ch\u00f3i nh\u0103n m\u1eb7t. Tr\u1ebb emth\u01b0\u1eddng t\u00fam l\u1ea5y tay hay g\u1ea1t tay th\u1ea7y thu\u1ed1c ra kh\u00f4ng cho kh\u00e1m ti\u1ebfp.<\/p>\n

C\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c c\u00f2n c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n b\u1eb1ng c\u00e1ch \u1ea5n \u0111\u1ea7u ng\u00f3n tr\u1ecf t\u1eeb t\u1eeb s\u00e2u d\u1ea7n,b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ea5y \u0111au nhi\u1ec1u nh\u01b0ng khi bu\u00f4ng tay \u0111\u1ed9t ng\u1ed9t b\u1ec7nh nh\u00e2n \u0111au ch\u00f3i r\u00f5r\u1ec7t (D\u1ea5u hi\u1ec7u Blumberg).<\/p>\n

B\u1ec7nh nh\u00e2n VPM \u0111\u1ebfn c\u00e0ng tr\u1ec5 d\u1ea5u hi\u1ec7u c\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c c\u00e0ng r\u00f5 r\u1ec7t. VPM \u1edf tr\u1ebbem, \u1edf ng\u01b0\u1eddi gi\u00e0 y\u1ebfu, BN suy ki\u1ec7t, tri\u1ec7u ch\u1ee9ng c\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c th\u01b0\u1eddng r\u00f5r\u1ec7t h\u01a1n tri\u1ec7u ch\u1ee9ng co c\u1ee9ng th\u00e0nh b\u1ee5ng.<\/p>\n

3. G\u00f5:<\/p>\n

\u0110\u1ec3 b\u1ec7nh nh\u00e2n n\u1eb1m h\u01a1i nghi\u00eang ph\u1ea3i, g\u00f5 \u1edf h\u00f4ng ph\u1ea3i, ho\u1eb7c \u0111\u1ec3 b\u1ec7nh nh\u00e2n n\u1eb1mnghi\u00eang tr\u00e1i, g\u00f5 \u1edf h\u00f4ng tr\u00e1i s\u1ebd nghe th\u1ea5y ti\u1ebfng \u0111\u1ee5c: \u0111\u1ee5c \u1edf v\u00f9ng th\u1ea5p.<\/p>\n

\u0110\u1ee5c v\u00f9ng th\u1ea5p l\u00e0 tri\u1ec7u ch\u1ee9ng t\u1ed1t ch\u1ee9ng t\u1ecf c\u00f3 d\u1ecbch trong xoang b\u1ee5ng nh\u01b0ngch\u1ec9 t\u00ecm khi c\u00e1c tri\u1ec7u ch\u1ee9ng co c\u1ee9ng v\u00e0 c\u1ea3m \u1ee9ng kh\u00f4ng r\u00f5 r\u1ec7t.<\/p>\n

\u0110\u1ec3 b\u1ec7nh nh\u00e2n n\u1eb1m \u0111\u1ea7u cao (t\u01b0 th\u1ebf Fowler), tr\u01b0\u1eddng h\u1ee3p trong xoang b\u1ee5ng c\u00f3 h\u01a1i,h\u01a1i s\u1ebd d\u1ed3n l\u00ean ph\u00eda tr\u00ean cao xen gi\u1eefa th\u00e0nh b\u1ee5ng tr\u01b0\u1edbc v\u00e0 gan l\u00e0m cho m\u1ea5t v\u00f9ng \u0111\u1ee5ctr\u01b0\u1edbc gan.<\/p>\n

M\u1ea5t v\u00f9ng \u0111\u1ee5c tr\u01b0\u1edbc gan l\u00e0 tri\u1ec7u ch\u1ee9ng t\u1ed1t cho ch\u1ea9n \u0111o\u00e1n th\u1ee7ng d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng(70-80% b\u1ec7nh nh\u00e2n th\u1ee7ng d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng c\u00f3 tri\u1ec7u ch\u1ee9ng m\u1ea5t v\u00f9ng \u0111\u1ee5c tr\u01b0\u1edbc gan).<\/p>\n

4. Nghe:<\/p>\n

Kh\u00f4ng nghe \u00e2m ru\u1ed9t hay ch\u1ec9 nghe th\u01b0a th\u1edbt do ru\u1ed9t b\u1ecb li\u1ec7t kh\u00f4ng co b\u00f3p hay ch\u1ec9co b\u00f3p r\u1ea5t y\u1ebfu \u1edbt. Tri\u1ec7u ch\u1ee9ng n\u00e0y \u00edt c\u00f3 gi\u00e1 tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n.<\/p>\n

5. Th\u0103m tr\u1ef1c tr\u00e0ng (hay th\u0103m \u00e2 m \u0111 \u1ea1 o \u1edf ph\u1ee5 n\u1eef \u0111\u00e3 c\u00f3 gia \u0111\u00ecnh).<\/p>\n

Th\u0103m tr\u1ef1c tr\u00e0ng l\u00e0 \u0111\u1ed9ng t\u00e1c b\u1eaft bu\u1ed9c cho m\u1ecdi tr\u01b0\u1eddng h\u1ee3p VPM, nh\u1ea5t l\u00e0 khi c\u00e1ctri\u1ec7u ch\u1ee9ng \u1edf th\u00e0nh b\u1ee5ng kh\u00f4ng r\u00f5 r\u1ec7t hay kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7.<\/p>\n

Th\u0103m tr\u1ef1c tr\u00e0ng cho ph\u00e9p\u0111\u1ee5ng ch\u1ea1m r\u1ea5t g\u1ea7n t\u1edbi ph\u00fac m\u1ea1c c\u1ee7a t\u00fai c\u00f9ng Douglas.Tr\u01b0\u1eddng h\u1ee3p t\u00fai c\u00f9ng Douglas c\u00f3 m\u00e1u, c\u00f3 m\u1ee7, c\u00f3 d\u1ecbch b\u1ea9n \u1ea5n v\u00e0o th\u00e0nh tr\u01b0\u1edbctr\u1ef1c tr\u00e0ng r\u1ea5t \u0111au: ti\u1ebfng k\u00eau Douglas.<\/p>\n

Ngo\u00e0i ra c\u00f2n c\u00f3 th\u1ec3 th\u1ea5y t\u00fai c\u00f9ng Douglasph\u1ed3ng l\u00ean.<\/p>\n

6. Ch\u1ecdc d\u00f2 xoang b\u1ee5ng<\/p>\n

Ch\u1ecdc d\u00f2 xoang b\u1ee5ng l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n ch\u1ea9n \u0111o\u00e1n sau khi m\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p tr\u00eankh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n.<\/p>\n

B\u1eb1ng kim to v\u00e0 d\u00e0i ch\u1ecdc \u1edf v\u00f9ng th\u1ea5p (n\u01a1i g\u00f5 th\u1ea5y \u0111\u1ee5c) th\u01b0\u1eddng \u1edf h\u00f4ng ph\u1ea3i v\u00e0 h\u1ed1ch\u1eadu ph\u1ea3i hay h\u00f4ng tr\u00e1i v\u00e0 h\u1ed1 ch\u1eadu tr\u00e1i, s\u1ebd h\u00fat \u0111\u01b0\u1ee3c m\u1ee7 ho\u1eb7c d\u1ecbch b\u1ea9n. X\u00e9t nghi\u1ec7md\u1ecbch h\u00fat: t\u00ecm vi tr\u00f9ng v\u00e0 l\u00e0m kh\u00e1ng sinh \u0111\u1ed3, n\u1ebfu c\u1ea7n thi\u1ebft ph\u00e2n t\u00edch th\u00e0nh ph\u1ea7n \u0111\u1ec3 x\u00e1c\u0111\u1ecbnh nguy\u00ean nh\u00e2n c\u1ee7a VPM.<\/p>\n

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

1. To\u00e0n th\u00e2n bi\u1ec3u hi\u1ec7n m\u1ed9t t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng.<\/p>\n

– V\u1ebb m\u1eb7t lo \u00e2u, h\u1ed1c h\u00e1c, m\u1eaft tr\u0169ng v\u00e0 th\u00e2m qu\u1ea7ng, m\u00f4i kh\u00f4, l\u01b0\u1ee1i d\u01a1, th\u1edf nhanhn\u00f4ng, c\u00e1nh m\u0169i ph\u1eadp ph\u1ed3ng. t\u1ea5t c\u1ea3 h\u1ecdp l\u1ea1i th\u00e0nh \u201cn\u00e9t m\u1eb7t c\u1ee7a ng\u01b0\u1eddi VPM\u201d<\/p>\n

– Th\u00e2n nhi\u1ec7t bao gi\u1edd c\u0169ng cao, nhi\u1ec7t \u0111\u1ed9 39-39,5-400C.<\/p>\n

2. N\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u1ebfn tr\u1ec5 sau v\u00e0i ng\u00e0y, t\u00ecnh tr\u1ea1ng r\u1ea5t n\u1eb7ng, bi\u1ec3u hi\u1ec7n m\u1ed9t t\u00ecnhtr\u1ea1ng nhi\u1ec5m \u0111\u1ed9c:<\/p>\n

– B\u1ec7nh nh\u00e2n l\u01a1 m\u01a1, l\u00fac ng\u1ee7 l\u00fac th\u1ee9c, n\u1eeda t\u1ec9nh n\u1eeda m\u00ea, n\u00f3i l\u1ea3m nh\u1ea3m.<\/p>\n

– M\u1ea1ch nhanh nh\u1ecf kh\u00f3 b\u1eaft c\u00f3 khi kh\u00f4ng c\u00f3 m\u1ea1ch. Huy\u1ebft \u00e1p t\u1ee5t, k\u1eb9p, c\u00f3 khikh\u00f4ng huy\u1ebft \u00e1p. B\u1ec7nh nh\u00e2n trong t\u00ecnh tr\u1ea1ng s\u1ed1c.<\/p>\n

– Th\u01b0\u1eddng c\u00f3 thi\u1ec3u ni\u1ec7u, n\u01b0\u1edbc ti\u1ec3u th\u1eabm m\u00e0u, mu\u1ed9n n\u1eefa c\u00f3 v\u00f4 ni\u1ec7u.<\/p>\n

B. C\u1eacN L\u00c2M S\u00c0NG<\/p>\n

I. Tri\u1ec7u ch\u1ee9ng v\u1ec1 x\u00e9t nghi\u1ec7m<\/p>\n

– CTM: s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng cao: b\u00ecnh th\u01b0\u1eddng 5\u20139 ngh\u00ecn\/mm3 l\u00ean t\u1edbi 15\u201320 ngh\u00ecn\/mm3hay h\u01a1n n\u1eefa. T\u1ec9 l\u1ec7 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednht\u0103ng cao, t\u1eeb 65 \u2013 70% l\u00ean t\u1edbi 85 \u2013 95%.<\/p>\n

– Tr\u00ean \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 th\u1ea5y c\u00f3 r\u1ed1i lo\u1ea1n tr\u1ea7m tr\u1ecdng c\u1ee7a c\u00e1c \u0111i\u1ec7n gi\u1ea3i Na+, Cl-, K+, v\u00e0d\u1ef1 tr\u1eef ki\u1ec1m.<\/p>\n

– \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ebfn tr\u1ec5 khi ch\u1ee9c n\u0103ng b\u00e0i th\u1ea3i \u0111\u00e3 b\u1ecb \u1ea3nh h\u01b0\u1edfng, th\u1ea5y:<\/p>\n

+ Ur\u00eam\u00e1u t\u0103ng cao: b\u00ecnh th\u01b0\u1eddng l\u00e0 25 \u2013 30mg\/100ml c\u00f3 th\u1ec3 t\u0103ng l\u00ean 100 \u2013 300mg\/100ml.<\/p>\n

+ L\u01b0\u1ee3ng ur\u00ea \u0111\u00e0o th\u1ea3i 24 gi\u1edd gi\u1ea3m th\u1ea5p.<\/p>\n

Ur\u00ea m\u00e1u v\u00e0 ur\u00ean\u01b0\u1edbc ti\u1ec3u l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 quan tr\u1ecdng \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng b\u00eanh. Khi ur\u00ea m\u00e1u t\u0103ng caod\u1ea7n, ur\u00ea n\u01b0\u1edbc ti\u1ec3u gi\u1ea3m d\u1ea7n h\u1ea7u nh\u01b0 kh\u00f4ng tr\u00e1nh kh\u1ecfi t\u1eed vong, ng\u01b0\u1ee3c l\u1ea1i khi ur\u00ea m\u00e1ugi\u1ea3m d\u1ea7n v\u00e0 ur\u00ea n\u01b0\u1edbc ti\u1ec3u t\u0103ng d\u1ea7n k\u00e8m v\u1edbi s\u1ed1 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u ng\u00e0y m\u1ed9t nhi\u1ec1u s\u1ebd d\u1ea7nd\u1ea7n t\u1edbi kh\u1ecfi.<\/p>\n

II. Tri\u1ec7u ch\u1ee9ng X-quang: Ch\u1ee5p b\u1ee5ng kh\u00f4ng s\u1eeda so\u1ea1n \u1edf t\u01b0 th\u1ebf \u0111\u1ee9ng. N\u1ebfu b\u1ec7nh nh\u00e2n y\u1ebfu, m\u1ea1ch huy\u1ebft \u00e1pkh\u00f4ng t\u1ed1t, ch\u1ee5p t\u01b0 th\u1ebf Fowler hay \u1edf t\u01b0 th\u1ebf n\u1eb1m nghi\u00eang tr\u00e1i.<\/p>\n

– C\u00f3 th\u1ec3 th\u1ea5y li\u1ec1m h\u01a1i d\u01b0\u1edbi c\u01a1 ho\u00e0nh hay m\u1ed9t hai b\u00ean khi VPM do th\u1ee7ng d\u1ea1 d\u00e0yt\u00e1 tr\u00e0ng hay do th\u1ee7ng ru\u1ed9t non. 80% b\u1ec7nh nh\u00e2n th\u1ee7ng d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng c\u00f3 li\u1ec1m h\u01a1i d\u01b0\u1edbic\u01a1 ho\u00e0nh.<\/p>\n

– B\u1ee5ng m\u1edd \u0111\u1ec1u.<\/p>\n

– Th\u00e0nh c\u00e1c quai ru\u1ed9t d\u1ea7y l\u00ean do c\u00f3 d\u1ecbch xen k\u1ebd n\u1eb1m gi\u1eefa hai quai ru\u1ed9t s\u00e1t k\u1ec1 b\u00eannhau.<\/p>\n

– C\u00e1c quai ru\u1ed9t gi\u00e3n to ch\u1ee9a nhi\u1ec1u h\u01a1i do c\u00f3 t\u00ecnh tr\u1ea1ng t\u1eafc ru\u1ed9t c\u01a1 n\u0103ng.<\/p>\n

– \u0110\u01b0\u1eddng s\u00e1ng 2 b\u00ean th\u00e0nh b\u1ee5ng m\u1ea5t \u0111i ho\u1eb7c b\u1ecb ng\u1eaft qu\u00e3ng (d\u1ea5u hi\u1ec7u Laurell).<\/p>\n

T\u00d3M L\u1ea0I: VPM to\u00e0n th\u1ec3 th\u1ee9 ph\u00e1t l\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ee7a nhi\u1ec1u b\u1ec7nh do r\u1ea5t nhi\u1ec1unguy\u00ean nh\u00e2n g\u00e2y n\u00ean. B\u00ean c\u1ea1nh c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh, c\u00f3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p tri\u1ec7u ch\u1ee9ng k\u00edn \u0111\u00e1o, m\u01a1 h\u1ed3, kh\u00f3 ch\u1ea9n\u0111o\u00e1n. N\u1ebfu b\u1ecf s\u00f3t m\u1ed9t tr\u01b0\u1eddng h\u1ee3p VPM kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9ukh\u00f4ng th\u1ec3 tr\u00e1nh kh\u1ecfi t\u1eed vong trong v\u00f2ng v\u00e0i ba ng\u00e0y.C\u00e2u 29: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a,nguy\u00ean nh\u00e2n ch\u1ea3y m\u00e1u trong.<\/p>\n

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

Ch\u1ea3y m\u00e1u trong l\u00e0 ch\u1ea3y m\u00e1u trong c\u00e1c khoang t\u1ef1 nhi\u00ean nh\u01b0ng kh\u00f4ng ch\u1ea3y ra ngo\u00e0i. Tr\u01b0\u1eddng h\u1ee3p tr\u00e0n m\u00e1u m\u00e0ng ngo\u00e0i tim kh\u00f4ng g\u00e2y h\u1ed9i ch\u1ee9ng ch\u1ea3y m\u00e1u trong m\u00e0 g\u00e2y h\u1ed9i ch\u1ee9ng ch\u00e8n \u00e9p tim c\u1ea5p.<\/p>\n

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

a. Do v\u1ee1 c\u00e1c t\u1ea1ng \u0111\u1eb7c : do ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c b\u1ec7nh l\u00fd<\/p>\n

– T\u1ea1ng trong \u1ed5 ph\u00fac m\u1ea1c : gan, l\u00e1ch, tu\u1ef5.<\/p>\n

– T\u1ea1ng ngo\u00e0i ph\u00fac m\u1ea1c + r\u00e1ch ph\u00fac m\u1ea1c : th\u1eadn.<\/p>\n

b.Do t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u : do ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c b\u1ec7nh l\u00fd.<\/p>\n

– Th\u00e0nh b\u1ee5ng ( kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng to\u00e0n b\u1ed9 c\u00e1c l\u1edbp th\u00e0nh b\u1ee5ng)<\/p>\n

– M\u1ea1ch m\u1ea1c treo, m\u1ea1c n\u1ed1i.<\/p>\n

– Ch\u1eefa ngo\u00e0i t\u1eed cung v\u1ee1.<\/p>\n

– V\u1ee1 t\u00fai ph\u1ed3ng \u0111\u1ed9ng m\u1ea1ch.<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng c\u00e1c m\u1ea1ch m\u00e1u l\u1edbn trong \u1ed5 b\u1ee5ng.<\/p>\n

c.Ch\u1ea3y m\u00e1u trong khoang m\u00e0ng ph\u1ed5i<\/p>\n

– Do t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u li\u00ean s\u01b0\u1eddn.<\/p>\n

– Do t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 ph\u1ed5i.<\/p>\n

– Do t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u trung th\u1ea5t v\u1ee1 v\u00e0o m\u00e0ng ph\u1ed5i<\/p>\n

C\u00e2u 30: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng ch\u1ea3y m\u00e1u trong.<\/p>\n

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

– Da xanh, ni\u00eam m\u1ea1c nh\u1ee3t, hoa m\u1eaft, ch\u00f3ng m\u1eb7t.<\/p>\n

– N\u1eb7ng h\u01a1n b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 v\u1eadt v\u00e3, gi\u00e3y d\u1ee5a, h\u1ed1t ho\u1ea3ng ho\u1eb7c n\u1eb1m im, th\u1edd \u01a1, \u0111\u00e1p \u1ee9ng ch\u1eadm.<\/p>\n

– T\u1ee9 chi l\u1ea1nh, c\u00f3 th\u1ec3 n\u1ed5i v\u00e2n t\u00edm.<\/p>\n

– M\u1ea1ch nhanh nh\u1ecf kh\u00f3 b\u1eaft ho\u1eb7c kh\u00f4ng b\u1eaft \u0111\u01b0\u1ee3c, huy\u1ebft \u00e1p h\u1ea1 ho\u1eb7c k\u1eb9t, c\u00f3 khi kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c.<\/p>\n

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

v Ch\u1ea3y m\u00e1u trong \u1ed5 b\u1ee5ng<\/p>\n

– Nh\u00ecn : b\u1ee5ng ch\u01b0\u1edbng do li\u1ec7t ru\u1ed9t.<\/p>\n

– S\u1edd : c\u00f3 c\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c, \u00edt khi g\u1eb7p co c\u1ee9ng th\u1ef1c s\u1ef1 nh\u01b0 vi\u00eam ph\u00fac m\u1ea1c<\/p>\n

– G\u00f5 : n\u1ebfu \u00edt d\u1ecbch c\u00f3 th\u1ec3 g\u00f5 \u0111\u1ee5c v\u00f9ng th\u1ea5p, d\u1ecbch l\u01b0\u1ee3ng v\u1eeba g\u00f5 \u0111\u1ee5c h\u00ecnh nan hoa, d\u1ecbch nhi\u1ec1u c\u00f3 th\u1ec3 g\u00f5 \u0111\u1ee5c to\u00e0n b\u1ee5ng<\/p>\n

– Th\u0103m tr\u1ef1c tr\u00e0ng, \u00e2 m \u0111 \u1ea1 o : t\u00fai c\u00f9ng Douglas c\u0103ng \u0111au. \u0110\u00e2y l\u00e0 tri\u1ec7u ch\u1ee9ng r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb.<\/p>\n

– D\u1ea5u hi\u1ec7u Kehr : b\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eefa \u0111\u1ea7u th\u1ea5p, n\u1ebfu \u1ed5 b\u1ee5ng c\u00f3 m\u00e1u th\u00ec m\u00e1u s\u1ebd d\u1ed3n ph\u00eda d\u01b0\u1edbi c\u01a1 ho\u00e0nh, k\u00edch th\u00edch th\u1ea7n kinh ho\u00e0nh g\u00e2y \u0111au vai th\u01b0\u1eddng l\u00e0 vai tr\u00e1i.<\/p>\n

– Ch\u1ecdc d\u00f2 \u1ed5 b\u1ee5ng : th\u01b0\u1eddng ch\u1ecdc t\u1ea1i b\u1ed1n \u0111i\u1ec3m giao nhau c\u1ee7a c\u00e1c \u0111\u01b0\u1eddng ph\u00e2n chia v\u00f9ng b\u1ee5ng ho\u1eb7c hai \u0111i\u1ec3m gi\u1eefa b\u1edd ngo\u00e0i c\u01a1 th\u1eb3ng to. Sau khi g\u00e2y t\u00ea ch\u1ed7 \u0111\u1ecbnh ch\u1ecdc, d\u00f9ng b\u01a1m ti\u00eam d\u00e0i v\u00e0 to ch\u1ecdc v\u00e0o th\u00e0nh b\u1ee5ng. Khi kim \u0111\u00e3 qua ph\u00fac m\u1ea1c v\u1eeba \u0111\u1ea9y nh\u1eb9 b\u01a1m ti\u00eam v\u1eeba h\u00fat. Ch\u1ecdc d\u00f2 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 d\u01b0\u01a1ng t\u00ednh khi h\u00fat ra m\u00e1u kh\u00f4ng \u0111\u00f4ng. N\u1ebfu \u1ed5 b\u1ee5ng \u00edt m\u00e1u h\u00fat kh\u00f4ng ra, ta b\u01a1m v\u00e0o qua kim ch\u1ecdc d\u00f2 500ml NaCl 0,90\/0 sau \u0111\u00f3 h\u00fat ra d\u1ecbch c\u00f3 m\u00e0u \u0111\u1ecf nh\u1ea1t, n\u1ebfu nghi ng\u1edd c\u00f3 th\u1ec3 quay ly t\u00e2m \u0111\u1ebfm s\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u. Ch\u1ecdc r\u1eefa \u1ed5 b\u1ee5ng d\u01b0\u01a1ng t\u00ednh khi h\u1ed3ng c\u1ea7u >100000\/mm3, b\u1ea1ch c\u1ea7u tr\u00ean 1000\/mm3.<\/p>\n

v Ch\u1ea3y m\u00e1u trong khoang m\u00e0ng ph\u1ed5i<\/p>\n

– B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 kh\u00f3 th\u1edf, t\u1ee9c ng\u1ef1c.<\/p>\n

– C\u00f3 h\u1ed9i ch\u1ee9ng ba gi\u1ea3m ( rung thanh gi\u1ea3m, g\u00f5 \u0111\u1ee5c, r\u00ec r\u00e0o ph\u1ebf nang gi\u1ea3m)<\/p>\n

– Ch\u1ecdc d\u00f2 m\u00e0ng ph\u1ed5i : b\u1ec7nh nh\u00e2n n\u1eb1m \u0111\u1ea7u cao ho\u1eb7c ng\u1ed3i n\u1ebfu \u0111\u01b0\u1ee3c, d\u00f9ng kim to g\u1eafn b\u01a1m ti\u00eam, ch\u1ecdc b\u1edd tr\u00ean x\u01b0\u01a1ng s\u01b0\u1eddn khoang gian s\u01b0\u1eddn 6 \u0111\u01b0\u1eddng n\u00e1ch gi\u1eefa, khi kim qua th\u00e0nh ng\u1ef1c ta d\u00f9ng b\u01a1m ti\u00eam h\u00fat, ch\u1ecdc d\u00f2 d\u01b0\u01a1ng t\u00ednh khi c\u00f3 m\u00e1u kh\u00f4ng \u0111\u00f4ng.<\/p>\n

C\u00c2U 27: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng t\u1eafc ru\u1ed9t.<\/p>\n

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

-H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc do n\u00f4n, do \u1ee9 trong xoang b\u1ee5ng, do \u1ee9 trongl\u00f2ng ru\u1ed9t.<\/p>\n

-S\u1ed1t nh\u1eb9 do m\u1ea5t n\u01b0\u1edbc v\u00e0 nhi\u1ec5m tr\u00f9ng d\u1ecbch \u1ee9 \u0111\u1ecdng tr\u00ean ch\u1ed7 t\u1eafc.<\/p>\n

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

-\u0110au b\u1ee5ng : \u0110au b\u1ee5ng bao gi\u1edd c\u0169ng l\u00e0 tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t c\u1ee7a b\u1ec7nh. T\u00ednh ch\u1ea5t \u0111autrong t\u1eafc ru\u1ed9t l\u00e0 \u0111au b\u1ee5ng th\u00e0nh c\u01a1n. C\u01a1n \u0111au c\u00f3 th\u1ec3 \u0111\u1ed9t ng\u1ed9t, d\u1eef d\u1ed9i. B\u1eaft \u0111\u1ea7u t\u1eeb r\u1ed1nho\u1eb7c m\u1ea1n s\u01b0\u1eddn v\u00e0 nhanh ch\u00f3ng lan to\u1ea3 kh\u1eafp \u1ed5 b\u1ee5ng. H\u1ecfi k\u1ef9 t\u00ednh ch\u1ea5t \u0111au c\u00f3 th\u1ec3 gi\u00faph\u01b0\u1edbng t\u1edbi c\u0103n nguy\u00ean g\u00e2y t\u1eafc.<\/p>\n

+ Trong t\u1eafc ru\u1ed9t do b\u00edt: \u0111au th\u01b0\u1eddng th\u00e0nh c\u01a1n \u0111i\u1ec3n h\u00ecnh, ngo\u00e0i c\u01a1n kh\u00f4ng\u0111au ho\u1eb7c \u0111au nh\u1eb9.<\/p>\n

+ Trong xo\u1eafn ru\u1ed9t:\u0111au kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t, d\u1eef d\u1ed9i nh\u01b0 xo\u1eafn v\u1eb7n, \u0111au li\u00ean t\u1ee5c,kh\u00f4ng th\u00e0nh c\u01a1n, lan ra sau l\u01b0ng ho\u1eb7c v\u00f9ng th\u1eaft l\u01b0ng, kh\u00f4ng c\u00f3 t\u01b0 th\u1ebf gi\u1ea3m \u0111au.<\/p>\n

-N\u00f4n : N\u00f4n xu\u1ea5t hi\u1ec7n \u0111\u1ed3ng th\u1eddi v\u1edbi c\u01a1n \u0111au nh\u01b0ng kh\u00f4ng l\u00e0m cho c\u01a1n \u0111au gi\u1ea3m \u0111i.<\/p>\n

L\u00fac \u0111\u1ea7u, n\u00f4n ra th\u1ee9c \u0103n, sau n\u00f4n d\u1ecbch m\u1eadt, mu\u1ed9n h\u01a1n ch\u1ea5t n\u00f4n c\u00f3 th\u1ec3 gi\u1ed1ng nh\u01b0 ph\u00e2n.<\/p>\n

T\u00ednh ch\u1ea5t n\u00f4n ph\u1ee5 thu\u1ed9c ch\u1ee7 y\u1ebfu v\u1ecb tr\u00ed t\u1eafc, n\u00f4n nhi\u1ec1u v\u00e0 s\u1edbm trong t\u1eafc ru\u1ed9t cao, n\u00f4n mu\u1ed9n ho\u1eb7c ch\u1ec9 bu\u1ed3n n\u00f4n trong t\u1eafc ru\u1ed9t th\u1ea5p.<\/p>\n

-B\u00ed trung \u0111\u1ea1i ti\u1ec7n : B\u00ed trung ti\u1ec7n c\u00f3 th\u1ec3 c\u00f3 ngay sau khi b\u1ec7nh kh\u1edfi ph\u00e1t v\u00e0i gi\u1edd. B\u00ed \u0111\u1ea1iti\u1ec7n nhi\u1ec1u khi kh\u00f4ng r\u00f5 r\u00e0ng, trong tr\u01b0\u1eddng h\u1ee3p t\u1eafc cao c\u00f3 th\u1ec3 th\u1ea5y c\u00f2n \u0111\u1ea1i ti\u1ec7n do \u0111\u00e0oth\u1ea3i c\u00e1c ch\u1ea5t b\u00e3 v\u00e0 ph\u00e2n d\u01b0\u1edbi ch\u1ed5 t\u1eafc. Nh\u01b0ng d\u00f9 c\u00f3 \u0111\u1ea1i ti\u1ec7n nh\u01b0ng kh\u00f4ng l\u00e0m h\u1ebft \u0111auhay gi\u1ea3m c\u01a1n \u0111au b\u1ee5ng.<\/p>\n

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

Nh\u00ecn : B\u1ee5ng ch\u01b0\u1edbng bao gi\u1edd c\u0169ng c\u00f3, tu\u1ef3 v\u1ecb tr\u00ed t\u1eafc cao hay th\u1ea5p m\u00e0 b\u1ee5ng ch\u01b0\u1edbngnhi\u1ec1u hay \u00edt. N\u1ebfu t\u1eafc ru\u1ed9t do xo\u1eafn th\u1ea5y b\u1ee5ng ch\u01b0\u1edbng l\u1ec7ch.<\/p>\n

-Quai ru\u1ed9t n\u1ed5i : \u1edf b\u1ec7nh nh\u00e2n c\u00f3 th\u00e0nh b\u1ee5ng m\u1ecfng, trong c\u01a1n \u0111au c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c quairu\u1ed9t n\u1ed5i r\u00f5. \u0110\u00e2y l\u00e0 tri\u1ec7u ch\u1ee9ng r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n.<\/p>\n

-D\u1ea5u hi\u1ec7u r\u1eafn b\u00f2: trong c\u01a1n \u0111au ta nh\u00ecn th\u1ea5y s\u00f3ng nhu \u0111\u1ed9ng c\u1ee7a c\u00e1c quai ru\u1ed9t dichuy\u1ec3n t\u1eeb ch\u1ed7 n\u00e0y \u0111\u1ebfn ch\u1ed7 kh\u00e1c. Mu\u1ed1n th\u1ea5y r\u00f5 ta nh\u00ecn ti\u1ebfp tuy\u1ebfn v\u1edbi th\u00e0nh b\u1ee5ng. \u0110\u00e2yl\u00e0 tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 quan tr\u1ecdng nh\u1ea5t.<\/p>\n

-C\u00f3 th\u1ec3 th\u1ea5y s\u1eb9o m\u1ed5 c\u0169 tr\u00ean th\u00e0nh b\u1ee5ng, \u0111\u00e2y l\u00e0 g\u1ee3i \u00fd cho ch\u1ea9n \u0111o\u00e1n t\u1eafc ru\u1ed9t sau m\u1ed5<\/p>\n

-C\u00f3 th\u1ec3 th\u1ea5y c\u00e1c tho\u00e1t v\u1ecb th\u00e0nh b\u1ee5ng.<\/p>\n

S\u1edd :C\u00f3 th\u1ec3 s\u1edd th\u1ea5y u, d\u1ecb v\u1eadt, b\u00fai giun\u2026Khi b\u1ec7nh nh\u00e2n \u0111\u1ebfn mu\u1ed9n, ru\u1ed9t \u0111\u00e3 ho\u1ea1i t\u1eed g\u00e2yvi\u00eam ph\u00fac m\u1ea1c th\u00ec c\u00f3 \u0111\u1ea7y \u0111\u1ee7 tri\u1ec7u ch\u1ee9ng c\u1ee7a vi\u00eam ph\u00fac m\u1ea1c<\/p>\n

-Th\u0103m tr\u1ef1c tr\u00e0ng bong tr\u1ef1c tr\u00e0ng r\u1ed1ng l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p. M\u00e1u d\u00ednh theo g\u0103ngtrong l\u1ed3ng ru\u1ed9t hay kh\u1ed1i u ru\u1ed9t. th\u0103m tr\u1ef1c tr\u00e0ng l\u00e0 ph\u01b0\u01a1ng ph\u00e1t t\u1ed1t nh\u1ea5t \u0111\u1ec3 ph\u00e1t hi\u1ec7nkh\u1ed1i ung th\u01b0 tr\u1ef1c tr\u00e0ng \u1edf th\u1ea5p g\u00e2y t\u1eafc ru\u1ed9t.<\/p>\n

G\u00f5 : g\u00f5 vang v\u00ec c\u00e1c quai ru\u1ed9t gi\u00e3n ch\u01b0\u1edbng \u0111\u1ea7y h\u01a1i.<\/p>\n

Nghe : trong c\u01a1n \u0111au nghe tr\u00ean th\u00e0nh b\u1ee5ng th\u1ea5y ti\u1ebfng r\u00e9o c\u1ee7a ru\u1ed9t m\u1ea1nh h\u01a1n, nhi\u1ec1uh\u01a1n v\u00e0 \u00e2m s\u1eafc cao h\u01a1n. Nghe r\u1ea5t c\u1ea7n thi\u1ebft khi c\u1ea7n ph\u00e2n bi\u1ec7t t\u1eafc ru\u1ed9t c\u01a1 h\u1ecdc v\u00e0 t\u1eafcru\u1ed9t c\u01a1 n\u0103ng.C\u00e2u 28: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng c\u1eadn l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng t\u1eafc ru\u1ed9t.<\/p>\n

1. Ch\u1ee5p X Quang b\u1ee5ng kh\u00f4ng chu\u1ea9n b\u1ecb :<\/p>\n

L\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh quantr\u1ecdng kh\u00f4ng nh\u1eefng gi\u00fap ch\u1ea9n \u0111o\u00e1n t\u1eafc ru\u1ed9t m\u00e0 c\u00f2n gi\u00fap x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed v\u00e0 c\u01a1 ch\u1ebf t\u1eafc.<\/p>\n

-T\u1eafc ru\u1ed9t non : c\u00f3 nhi\u1ec1u m\u1ee9c n\u01b0\u1edbc h\u01a1i t\u1eadp trung gi\u1eefa b\u1ee5ng, k\u00edch th\u01b0\u1edbc nh\u1ecf, v\u00f2mth\u1ea5p, ch\u00e2n r\u1ed9ng, th\u00e0nh m\u1ecfng, c\u00f3 h\u00ecnh c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c ngang.<\/p>\n

-T\u1eafc \u0111\u1ea1i tr\u00e0ng : c\u00f3 \u00edt m\u1ee9c n\u01b0\u1edbc h\u01a1i, k\u00edch th\u01b0\u1edbc l\u1edbn, v\u00f2m cao, ch\u00e2n h\u1eb9p, n\u1eb1m \u1edf r\u00eca \u1ed5b\u1ee5ng, c\u00f3 c\u00e1c b\u01b0\u1edbu v\u00e0 c\u00e1c r\u00e3nh tr\u00ean b\u1edd ru\u1ed9t.<\/p>\n

-Trong t\u1eafc ru\u1ed9t c\u01a1 n\u0103ng:c\u1ea3 ru\u1ed9t non v\u00e0 \u0111\u1ea1i tr\u00e0ng \u0111\u1ec1u gi\u00e3n, ch\u1ee7 y\u1ebfuch\u1ee9 h\u01a1i, \u00edt khic\u00f3 m\u1ee9c n\u01b0\u1edbc h\u01a1i.<\/p>\n

2. Ch\u1ee5p \u0111\u1ea1i tr\u00e0ng c\u1ea3n quang<\/p>\n

-Ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng nghi ng\u1edd c\u00f3 t\u1eafc \u1edf \u0111\u1ea1i tr\u00e0ng.Trong tr\u01b0\u1eddng h\u1ee3p manh trang gi\u00e3n to ho\u1eb7c t\u1eafc \u0111\u1ea1i tr\u00e0ng c\u00f3 s\u1ed1t, t\u1ed1t nh\u1ea5t l\u00e0 ch\u1ee5p \u0111\u1ea1itr\u00e0ng c\u00f3 thu\u1ed1c c\u1ea3n quang ho\u00e0 trong n\u01b0\u1edbc.Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh khi c\u00f3 th\u1ee7ng ru\u1ed9t ho\u1eb7c nghing\u1edd c\u00f3 th\u1ee7ng ru\u1ed9t.<\/p>\n

-Ch\u1ee5p khung \u0111\u1ea1i tr\u00e0ng c\u00f3 c\u1ea3n quang tr\u01b0\u1edbc h\u1ebft x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed t\u1eafc v\u00e0 c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh\u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n t\u1eafc.<\/p>\n

+ Trong t\u1eafc \u0111\u1ea1i tr\u00e0ng sigma, thu\u1ed1c c\u1ea3n quang d\u1eebng l\u1ea1i \u1edf tr\u1ef1ctr\u00e0ng v\u00e0 c\u00f3 h\u00ecnh m\u1ecf chim.<\/p>\n

+ Trong t\u1eafc \u0111\u1ea1i tr\u00e0ng do \u0111\u1ea1I tr\u00e0ng c\u00f3 thu\u1ed1c u, thu\u1ed1c c\u1ea3nquang d\u1eebng l\u1ea1i \u1edf v\u1ecb tr\u00ed u v\u00e0 c\u00f3 h\u00ecnh c\u1eaft c\u1ee5t nham nh\u1edf.<\/p>\n

+ Trong l\u1ed3ng ru\u1ed9t, c\u00f3 h\u00ecnh \u0111\u00e1ych\u00e9n, h\u00ecnh c\u00e0ng cua, h\u00ecnh \u0111inh ba, h\u00ecnh huy ch\u01b0\u01a1ng.<\/p>\n

3. Ch\u1ee5p l\u01b0u th\u00f4ng ru\u1ed9t non<\/p>\n

Ch\u1ee5p l\u01b0u th\u00f4ng ru\u1ed9t non b\u1eb1ng c\u00e1ch cho b\u1ec7nh nh\u00e2n u\u1ed1ng thu\u1ed1c c\u1ea3n quang ho\u1eb7c \u0111\u1eb7t\u1ed1ng th\u00f4ng xu\u1ed1ng t\u00e1 tr\u00e0ng v\u00e0 b\u01a1m 40-100ml thu\u1ed1c c\u1ea3n quang ho\u00e0 tan trong n\u01b0\u1edbc, theod\u00f5i s\u1ef1 l\u01b0u th\u00f4ng c\u1ee7a ru\u1ed9t non trong v\u00f2ng 4-24h v\u00e0 c\u1ee9 30ph\u00fat ch\u1ee5p m\u1ed9t phim.<\/p>\n

Trong t\u1eafc ru\u1ed9t c\u1ea5p t\u00ednh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p l\u01b0u th\u00f4ng ru\u1ed9t non tr\u1eeb tr\u01b0\u1eddng h\u1ee3p t\u1eafc ru\u1ed9t sau m\u1ed5 t\u00e1i di\u1ec5n nhi\u1ec1u l\u1ea7n v\u00e0 t\u1eafc ru\u1ed9t kh\u00f4ng ho\u00e0n to\u00e0n, sau khi \u0111\u00e3 lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c t\u1eafc \u1edf \u0111\u1ea1i tr\u00e0ng. Ch\u1ee5p l\u01b0u th\u00f4ng ru\u1ed9t non c\u00f3 th\u1ec3 th\u1ea5y \u0111\u01b0\u1ee3c c\u00e1c quai ru\u1ed9t non gi\u00e3n tr\u00ean ch\u1ed7 t\u1eafc nh\u01b0ng kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c v\u1ecb tr\u00ed tr\u1eafc v\u00e0 nguy\u00ean nh\u00e2n t\u1eafc.<\/p>\n

4. Si\u00eau \u00e2m :<\/p>\n

Si\u00eau \u00e2m \u1ed5 b\u1ee5ng th\u1ea5y quai ru\u1ed9t gi\u00e3n ch\u1ee9a nhi\u1ec1u d\u1ecbch, c\u00f3 d\u1ea5u hi\u1ec7u m\u00e1y gi\u1eb7t do d\u1ecbch di chuy\u1ec3n t\u1edbi lui trong l\u00f2ng ru\u1ed9t.<\/p>\n

Trong giai \u0111o\u1ea1n \u0111\u1ea7u khi ru\u1ed9t ch\u01b0a gi\u00e3n si\u00eau \u00e2m c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n t\u1eafc nh\u01b0 l\u1ed3ng ru\u1ed9t, kh\u1ed1i u, \u00e1p xe trong \u1ed5 b\u1ee5ng\u2026<\/p>\n

5. C\u00e1c x\u00e9t nghi\u1ec7m m\u00e1u v\u00e0 sinh ho\u00e1 :<\/p>\n

C\u00f3 gi\u00e1 tr\u1ecb \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng to\u00e0n th\u00e2n b\u1ec7nh nh\u00e2n, gi\u00fap cho c\u00f4ng t\u00e1c h\u1ed3i s\u1ee9c v\u00e0 \u0111i\u1ec1u ch\u1ec9nh c\u00e1c r\u1ed1i lo\u1ea1n sinh l\u00fd c\u1ee7a t\u1eafc ru\u1ed9t<\/p>\n

6. X\u00e9t nghi\u1ec7m m\u00e1u :<\/p>\n

H\u1ed3ng c\u1ea7u t\u0103ng, Hct t\u0103ng do m\u1ea5t n\u01b0\u1edbc, m\u00e1u b\u1ecb c\u00f4 \u0111\u1eb7c. B\u1ea1ch c\u1ea7u t\u0103ng do nhi\u1ec5m tr\u00f9ng.<\/p>\n

R\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i : Na + , K + ,Cl – gi\u1ea3m do n\u00f4n nhi\u1ec1u. Ur\u00ea v\u00e0 Creatinin m\u00e1u t\u0103ng khi b\u1ec7nh nh\u00e2n \u0111\u1ebfn mu\u1ed9n, ch\u1ee9c n\u0103ng l\u1ecdc c\u1ee7a th\u1eadn b\u1ecb \u1ea3nh h\u01b0\u1edfng.<\/p>\n

C\u00e2u 44: Tr\u00ecnh b\u00e0y sinh l\u00fd b\u1ec7nh v\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ee7a t\u1eafc ru\u1ed9t?<\/p>\n

1. T\u1eafc ru\u1ed9t do b\u00edt:<\/p>\n

– Trong t\u1eafc \u1edf ru\u1ed9t non: \u1ea3nh h\u01b0\u1edfng l\u00ean \u0111o\u1ea1n ru\u1ed9t tr\u00ean ch\u1ed5 t\u1eafc x\u1ea3y ra r\u1ea5t nhanh ch\u00f3ng v\u00e0 n\u1eb7ng n\u1ec1. L\u00fac \u0111\u1ea7u do c\u01a1 ch\u1ebf th\u1ea7n kinh, c\u00e1c s\u00f3ng nhu \u0111\u1ed9ng ru\u1ed9t t\u0103ng r\u1ea5t m\u1ea1nh \u1edf \u0111o\u1ea1n ru\u1ed9t tr\u00ean ch\u1ed5 t\u1eafc nh\u1eb1m th\u1eafng s\u1ef1 c\u1ea3n tr\u1edf, c\u00e1c s\u00f3ng nhu \u0111\u1ed9ng \u0111\u00f3 g\u00e2y ra c\u00e1c c\u01a1n \u0111au v\u00e0 d\u1ea5u hi\u1ec7u r\u1eafn b\u00f2 tr\u00ean th\u00e0nh b\u1ee5ng. V\u1ec1 sau c\u00e1c s\u00f3ng nhu \u0111\u1ed9ng gi\u1ea3m d\u1ea7n v\u00e0 m\u1ea5t khi th\u00e0nh ru\u1ed9t b\u1ecb t\u1ed5n th\u01b0\u01a1ng.<\/p>\n

– Ru\u1ed9t tr\u00ean ch\u1ed5 t\u1eafc gi\u00e3n d\u1ea7n l\u00ean do ch\u1ee9a h\u01a1i v\u00e0 d\u1ecbch. Tr\u00ean 70% h\u01a1i trong \u1ed1ng ti\u00eau ho\u00e1 l\u00e0 do nu\u1ed1t v\u00e0o ph\u1ea7n c\u00f2n l\u1ea1i l\u00e0 do vi khu\u1ea9n ph\u00e2n hu\u1ef7 th\u1ee9c \u0103n l\u00ean men v\u00e0 sinh h\u01a1i. D\u1ecbch l\u00e0 do b\u00e0i ti\u1ebft c\u1ee7a \u0111\u01b0\u1eddng ti\u00eau ho\u00e1, ru\u1ed9t b\u00e0i ti\u00eat trung b\u00ecnh l\u00e0 6L\/24h. s\u1ef1 t\u0103ng \u00e1p l\u1ef1c trong l\u00f2ng ru\u1ed9t g\u00e2y \u1ee9 tr\u1ec7 t\u0129nh m\u1ea1ch, gi\u1ea3m t\u01b0\u1edbi m\u00e1u mao m\u1ea1ch \u1edf th\u00e0nh ru\u1ed9t l\u00e0m cho ni\u00eam m\u1ea1c ru\u1ed9t b\u1ecb t\u1ed5n th\u01b0\u01a1ng, ph\u00f9 n\u1ec1, xung huy\u1ebft, d\u1eabn t\u1edbi gi\u1ea3m d\u1ea7n, ho\u1eb7c m\u1ea5t h\u1eb3n qu\u00e1 tr\u00ecnh h\u1ea5p thu dung d\u1ecbch ti\u00eau ho\u00e1, g\u00e2y \u1ee9 \u0111\u1ecdng dung d\u1ecbch trong l\u00f2ng ru\u1ed9t.<\/p>\n

– N\u00f4n v\u00e0 ph\u1ea3n x\u1ea1 tr\u00e0o d\u1ecbch l\u00ean cao tr\u00ean ch\u1ed7 t\u1eafc c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m b\u1edbt ph\u1ea7n n\u00e0o s\u1ef1 t\u0103ng \u00e1p l\u1ef1c trong l\u00f2ng ru\u1ed9t. Nh\u01b0ng n\u00f4n nhi\u1ec1u, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong c\u00e1c t\u1eafc ru\u1ed9t cao \u0111\u00e3 l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc, r\u1ed1i lo\u1ea1n c\u00e1c ch\u1ea5t \u0111i\u1ec7n gi\u1ea3i v\u00e0 th\u0103ng b\u1eb1ng ki\u1ec1m toan.<\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m sinh ho\u00e1, huy\u1ebft h\u1ecdc cho th\u1ea5y c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n, m\u00e1u c\u1ed1 \u0111\u1eb7c v\u1edbi hematocrit, protid m\u00e1c t\u0103ng cao.<\/p>\n

– R\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i: Na+ m\u00e1u gi\u1ea3m do d\u1ecbch \u1ee9 \u0111\u1ecdng trong l\u00f2ng ru\u1ed9t ch\u1ee9a nhi\u1ec1u Na+. K+,Cl \u2013 m\u00e1u th\u01b0\u1eddng gi\u1ea3m do trong d\u1ecbch n\u00f4n c\u00f3 ch\u1ee9a nhi\u1ec1u K+, Cl-. K+ m\u00e1u t\u0103ng trong giai \u0111o\u1ea1n mu\u1ed9n khi t\u1ebf b\u00e0o th\u00e0nh ru\u1ed9t ho\u1ea1i t\u1eed, gi\u1ea3i ph\u00f3ng ra nhi\u1ec1u K+. Ure, creatinin m\u00e1u th\u01b0\u1eddng cao do c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng suy th\u1eadn ch\u1ee9c n\u0103ng v\u00e0 nhanh ch\u00f3ng h\u1ed3i ph\u1ee5c n\u1ebfu \u0111\u01b0\u1ee3c h\u1ed3i s\u1ee9c t\u1ed1t.<\/p>\n

– R\u1ed1i lo\u1ea1n th\u0103ng b\u1eb1ng ki\u1ec1m toan: th\u01b0\u1eddng c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng ki\u1ec1m chuy\u1ec3n ho\u00e1 do n\u00f4n d\u1ecbch d\u1ea1 d\u00e0y ch\u1ee9a nhi\u1ec1u HCl v\u00e0 di chuy\u1ec3n g\u1ed1c CHO3- t\u1eeb trong t\u1ebf b\u00e0o ra ngo\u00e0i t\u1ebf b\u00e0o, \u00edt khi c\u00f3 toan chuy\u1ec3n ho\u00e1 v\u1edbi K+ m\u00e1u cao. Cu\u1ed1i c\u00f9ng, b\u1ee5ng ch\u01b0\u1edbng, c\u01a1 ho\u00e0nh b\u1ecb \u0111\u1ea9y l\u00ean cao l\u00e0m gi\u1ea3m th\u00f4ng kh\u00ed, l\u00e0m \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u01a1 ch\u1ebf b\u00f9.<\/p>\n

– \u1ede d\u01b0\u1edbi ch\u1ed7 t\u1eafc, trong nh\u1eefng gi\u1edd \u0111\u1ea7u, nhu \u0111\u1ed9ng ru\u1ed9t \u0111\u1ea9y ph\u00e2n v\u00e0 h\u01a1i xu\u1ed1ng d\u01b0\u1edbi l\u00e0m ru\u1ed9t x\u1eb9p xu\u1ed1ng v\u00e0 kh\u00f4ng c\u00f3 h\u01a1i.<\/p>\n

– T\u1eafc \u1edf \u0111\u1ea1i tr\u00e0ng, c\u00e1c h\u1eadu qu\u1ea3 t\u1ea1i ch\u1ed7 v\u00e0 to\u00e0n th\u00e2n c\u0169ng x\u1ea3y ra nh\u01b0 trong t\u1eafc ru\u1ed9t non nh\u01b0ng ch\u1eadm v\u00e0 mu\u1ed9n h\u01a1n. Hi\u1ec7n t\u01b0\u01a1ng t\u0103ng s\u00f3ng nhu \u0111\u1ed9ng tr\u00ean ch\u1ed7 t\u1eafc \u00edt g\u1eb7p, ru\u1ed9t gi\u00e3n to, ch\u1ee9a nhi\u1ec1u kh\u00ed h\u01a1n d\u1ecbch do c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng l\u00ean men c\u1ee7a vi khu\u1ea9n \u1edf \u0111\u1ea1i tr\u00e0ng. N\u1ebfu van bauhin m\u1edf ra khi \u00e1p l\u1ef1c trong \u0111\u1ea1i tr\u00e0ng cao do \u1ee9 \u0111\u1ecdng d\u1ecbch v\u00e0 h\u01a1i tr\u00ean ch\u1ed7 t\u1eafc, d\u1ecbch tr\u00e0o l\u00ean ru\u1ed9t non v\u00e0 h\u1eadu qu\u1ea3 x\u1ea3y ra c\u0169ng nh\u01b0 trong t\u1eafc ru\u1ed9t non. N\u1ebfu van n\u00e0y t\u1ef1 ch\u1ee7, \u0111\u00f3ng k\u00edn, ph\u00e2n v\u00e0 h\u01a1i c\u1ee7a \u0111\u1ea1i tr\u00e0ng kh\u00f4ng tr\u00e0n l\u00ean ru\u1ed9t non \u0111\u01b0\u1ee3c, \u0111\u1ea1i tr\u00e0ng gi\u00e3n r\u1ea5t to, \u00e1p l\u1ef1c trong l\u00f2ng \u0111\u1ea1i tr\u00e0ng r\u1ea5t l\u1edbn v\u00e0 c\u00f3 nguy c\u01a1 v\u1ee1 \u0111\u1ea1i tr\u00e0ng do c\u0103ng gi\u00e3n. \u00c1p l\u1ee5c cao nh\u1ea5t \u1edf manh tr\u00e0ng v\u00ec manh tr\u00e0ng c\u00f3 k\u00edch th\u01b0\u1edbc l\u1edbn nh\u1ea5t. Do v\u1eady, trong t\u1eafc \u0111\u1ea1i tr\u00e0ng, v\u1ecb tr\u00ed b\u1ecb th\u1ee7ng, v\u1ee1 nhi\u1ec1u nh\u1ea5t l\u00e0 \u1edf manh tr\u00e0ng.<\/p>\n

2. T \u1eafc ru\u1ed9t do th\u1eaft ngh\u1eb9t:<\/p>\n

– Xo\u1eafn ru\u1ed9t l\u00e0 h\u00ecnh th\u00e1i \u0111i\u1ec3n h\u00ecnh nh\u1ea5t v\u00e0 h\u1eadu qu\u1ea3 c\u0169ng x\u1ea3y ra nhanh ch\u00f3ng v\u00e0 n\u1eb7ng n\u1ec1 nh\u1ea5t trong c\u00e1c lo\u1ea1i t\u1eafc ru\u1ed9t do c\u00f3 ch\u1ebf th\u1eaft ngh\u1eb9t. C\u00e1c r\u1ed1i lo\u1ea1n to\u00e0n th\u00e2n v\u00e0 t\u1ea1i ch\u1ed7 m\u1ed9t ph\u1ea7n do \u1ea3nh h\u01b0\u1edfng c\u1ee7a ru\u1ed9t tr\u00ean ch\u1ed7 t\u1eafc g\u00e2y ra nh\u01b0 trong t\u1eafc ru\u1ed9t do b\u00edt t\u1eafc nh\u01b0ng ch\u1ee7 y\u00ea\u00fa l\u00e0 do quai ru\u1ed9t v\u00e0 m\u1ea1ch m\u00e1u m\u1ea1c treo t\u01b0\u01a1ng \u1ee9ng b\u1ecb ngh\u1eb9t l\u1ea1i g\u00e2y ra.<\/p>\n

– Quai ru\u1ed9t b\u1ecb xo\u1eafn, ngh\u1eb9t gi\u00e3n to, ch\u1ee9a d\u1ecbch l\u00e0 ch\u1ee7 y\u1ebfu, h\u01a1i r\u1ea5t \u00edt, tr\u1eeb xo\u1eafn \u0111\u1ea1i tr\u00e0ng, trong quai ru\u1ed9t xo\u1eafn c\u00f3 nhi\u1ec1u h\u01a1i l\u00e0 do vi khu\u1ea9n l\u00ean men. S\u1ef1 \u1ee9 tr\u1ec7 t\u0129nh m\u1ea1ch \u1edf quai ru\u1ed9t b\u1ecb xo\u1eafn l\u00e0m tho\u00e1t huy\u1ebft t\u01b0\u01a1ng v\u00e0 m\u00e1u v\u00e0o trong quai ru\u1ed9t b\u1ecb xo\u1eafn v\u00e0 v\u00e0o trong \u1ed5 b\u1ee5ng. Ru\u1ed9t b\u1ecb t\u1ed5n th\u01b0\u01a1ng l\u00e0m cho h\u00e0ng r\u00e0o b\u1ea3o v\u1ec7 c\u1ee7a ni\u00eam m\u1ea1c ru\u1ed9t b\u1ecb ph\u00e1 hu\u1ef7, s\u1ef1 t\u0103ng sinh c\u1ee7a vi khu\u1ea9n trong quai ru\u1ed9t b\u1ecb ho\u1ea1i t\u1eed do \u1ee9 tr\u1ec7 trong l\u00f2ng ru\u1ed9t l\u00e0m cho n\u1ed9i \u0111\u1ed9c t\u1ed1 c\u1ee7a vi khu\u1ea9n c\u00f3 th\u1ec3 tho\u00e1t v\u00e0o \u1ed5 ph\u00fac m\u1ea1c. \u1ede \u0111\u00e2y n\u1ed9i \u0111\u1ed9c t\u1ed1 c\u1ee7a vi khu\u1ea9n \u0111\u01b0\u1ee3c h\u1ea5p thu. Do \u0111\u00f3 c\u01a1 ch\u1ebf s\u1ed1c trong t\u1eafc ru\u1ed9t do th\u1eaft ngh\u1eb9t l\u00e0 nhi\u1ec5m \u0111\u1ed9c, nhi\u1ec5m khu\u1ea9n ph\u1ed1i h\u1ee3p v\u1edbi gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n. Trong lo\u1ea1i t\u1eafc ru\u1ed9t n\u00e0y, \u0111\u1ed9ng m\u1ea1ch m\u1ea1c treo t\u01b0\u01a1ng \u1ee9ng c\u0169ng b\u1ecb ngh\u1eb9t l\u00e0m cho quai ru\u1ed9t n\u00e0y b\u1ecb thi\u1ebfu m\u00e1u nu\u00f4i d\u01b0\u1ee1ng v\u00e0 cu\u1ed1i c\u00f9ng b\u1ecb ho\u1ea1i t\u1eed, v\u1ee1 v\u00e0o \u1ed5 b\u1ee5ng g\u00e2y vi\u00eam ph\u00fac m\u1ea1c<\/p>\n

– Trong tr\u01b0\u1eddng h\u1ee3p l\u1ed3ng ru\u1ed9t c\u1ea5p t\u00ednh, c\u1ed5 c\u1ee7a kh\u1ed1i l\u1ed3ng l\u00e0m ngh\u1eb9t \u0111o\u1ea1n ru\u1ed9t l\u1ed3ng c\u00f9ng v\u1edbi m\u1ea1c treo v\u00e0 h\u1eadu qu\u1ea3 t\u1ea1i ch\u1ed7 l\u00e0 ch\u1ea3y m\u00e1u trong l\u00f2ng ru\u1ed9t, ho\u1ea1i t\u1eed kh\u1ed1i l\u1ed3ng v\u00e0 c\u00e1c h\u1eadu qu\u1ea3 to\u00e0n th\u00e2n nh\u01b0 trong xo\u1eafn ru\u1ed9t.<\/p>\n

3. T\u1eafc ru\u1ed9t do li\u1ec7t ru\u1ed9t.<\/p>\n

Trong t\u1eafc ru\u1ed9t ru\u1ed9t c\u01a1 n\u0103ng do li\u1ec7t ru\u1ed9t m\u00e0 c\u00e1c nguy\u00ean nh\u00e2n l\u00e0 c\u00e1c b\u1ec7nh c\u1ea5p t\u00ednh \u1edf \u1ed5 b\u1ee5ng, h\u1eadu qu\u1ea3 t\u1ea1i ch\u1ed7 v\u00e0 to\u00e0n th\u00e2n thay \u0111\u1ed5i tu\u1ef3 theo t\u1eebng nguy\u00ean nh\u00e2n \u0111\u00f3. Trong li\u1ec7t ru\u1ed9t c\u01a1 n\u0103ng do ph\u1ea3n x\u1ea1, h\u1eadu qu\u1ea3 c\u1ee7a t\u1eafc ru\u1ed9t t\u1edbi to\u00e0n th\u00e2n v\u00e0 t\u1ea1i ch\u1ed7 di\u1ec5n ra t\u1eeb t\u1eeb v\u00e0 r\u1ea5t mu\u1ed9n. Ru\u1ed9t ch\u01b0\u1edbng r\u1ea5t s\u1edbm v\u00e0 nhi\u1ec1u, ch\u01b0\u1edbng h\u01a1i l\u00e0 ch\u00ednh. \u00cdt khi c\u00f3 n\u00f4n v\u00ec ru\u1ed9t kh\u00f4ng c\u00f3 nhu \u0111\u1ed9ng. L\u01b0\u1ee3ng d\u1ecbch \u1ee9 \u0111\u1ecdng trong l\u00f2ng ru\u1ed9t \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n l\u00e2u h\u01a1n. Do v\u1eady, c\u00e1c h\u1eadu qu\u1ea3 to\u00e0n th\u00e2n v\u00e0 t\u1ea1i ch\u1ed7 nh\u1eb9 x\u1ea3y ra mu\u1ed9n.<\/p>\n

C\u00e2u 7: Tr\u00ecnh b\u00e0y c\u00e1ch ph\u00e2n bi\u1ec7t vi\u00eam ph\u00fac m\u1ea1c v\u1edbi h\u1ed9i ch\u1ee9ng ch\u1ea3y m\u00e1u trong \u1ed5 b\u1ee5ng v\u1edbi t\u1eafc ru\u1ed9t c\u01a1 h\u1ecdc<\/p>\n

Vi\u00eam ph\u00fac m\u1ea1c<\/p>\n

Ch\u1ea3y m\u00e1u \u1ed5 b\u1ee5ng<\/p>\n

T\u1eafc ru\u1ed9t c\u01a1 h\u1ecdc<\/p>\n

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

– \u0110au b\u1ee5ng: Li\u00ean t\u1ee5c d\u1eef d\u1ed9i b\u1ec7nh nh\u00e2n n\u1eb1m im kh\u00f4ng d\u00e1m thay \u0111\u1ed5i t\u01b0 th\u1ebf kh\u00f4ng d\u00e1m th\u1edf m\u1ea1nh , ho<\/p>\n

– N\u00f4n: Nh\u01b0ng kh\u00f4ng n\u00f4n nhi\u1ec1u nh\u01b0 t\u1eafc ru\u1ed9t sau n\u00f4n BN kh\u00f4ng \u0111\u1ee1 \u0111au<\/p>\n

– B\u00ed tr\u00fang \u0111\u1ea1i ti\u1ec7n: Kh\u00f4ng r\u00f5 r\u00e0ng BN v\u1eabn c\u00f3 th\u1ec3 trung \u0111\u1ea1i ti\u1ec7n \u0111\u01b0\u1ee3c<\/p>\n

– Da xanh, ni\u00eam m\u1ea1c nh\u1ee3t, hoa m\u1eaft,ch\u00f3ng m\u1eb7t.<\/p>\n

– N\u1eb7ng h\u01a1n, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 v\u1eadt v\u00e3, h\u1ed1t ho\u1ea3ng ho\u1eb7c th\u1edd \u01a1, \u0111\u00e1p \u1ee9ng ch\u1eadm.<\/p>\n

– T\u1ee9 chi l\u1ea1nh, c\u00f3 th\u1ec3 n\u1ed5i v\u00e2n t\u00edm.<\/p>\n

– M\u1ea1ch nhanh nh\u1ecf, kh\u00f3 b\u1eaft ho\u1eb7c kh\u00f4ng b\u1eaft \u0111\u01b0\u1ee3c, huy\u1ebft \u00e1p h\u1ea1 ho\u1eb7c k\u1eb9p, c\u00f3 khi kh\u00f4ng \u0111o \u0111\u01b0\u1ee3c<\/p>\n

+ \u0110au b\u1ee5ng th\u00e0nh c\u01a1n m\u1ed7i c\u01a1n \u0111au k\u00e9o d\u00e0i kho\u1ea3ng 30 gi\u00e2y c\u00e1ch nhau v\u00e0i ba ph\u00fat trong t\u1eafc ru\u1ed9t n\u00f4n , 15-20 ph\u00fat trong t\u1eafc \u0111\u1ea1i tr\u00e0ng<\/p>\n

+ N\u00f4n: T\u00f9y theo v\u1ecb tr\u00ed t\u1eafc :t\u1eafc c\u00e0ng cao n\u00f4n c\u00e0ng s\u1edbm, nhi\u1ec1u v\u00e0 ng\u01b0\u1ee3c l\u1ea1i<\/p>\n

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

H\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u1ec7m to\u00e0n th\u00e2n: s\u1ed1t cao, m\u1ea1ch nhanh, m\u00f4i kh\u00f4, l\u01b0\u1ee1i b\u1ea9n, v\u1ebb m\u1eb7t h\u1ed1c h\u00e1c<\/p>\n

– H\u1ea7u h\u1ebft BN c\u00f3 t\u00ecnh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc do n\u00f4n, \u1ee9 trong xoang b\u1ee5ng, l\u00f2ng ru\u1ed9t<\/p>\n

– S\u1ed1t nh\u1eb9 do m\u1ea5t n\u01b0\u1edbc v\u00e0 nhi\u1ec5m tr\u00f9ng do d\u1ecbch \u1ee9 \u0111\u1ecdng tr\u00ean ch\u1ed5 t\u1eafc<\/p>\n

T.c th\u1ef1c th\u1ec3<\/p>\n

Nh\u00ecn<\/p>\n

B\u1ee5ng ch\u01b0\u1edbng , b\u1ee5ng \u00edt di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf<\/p>\n

B\u1ee5ng ch\u01b0\u1edbng do li\u1ec7t ru\u1ed9t<\/p>\n

-B\u1ee5ng ch\u01b0\u1edbng.<\/p>\n

– Quai ru\u1ed9t n\u1ed5i.<\/p>\n

– D\u1ea5u hi\u1ec7u r\u1eafn b\u00f2.<\/p>\n

– C\u00f3 th\u1ec3 th\u1ea5y s\u1eb9o m\u1ed5 c\u0169 tr\u00ean th\u00e0nh b\u1ee5ng.<\/p>\n

– C\u00f3 th\u1ec3 th\u1ea5y c\u00e1c tho\u00e1t v\u1ecb th\u00e0nh b\u1ee5ng<\/p>\n

S\u1edd<\/p>\n

B\u1ee5ng g\u1ed3ng c\u1ee9ng(b\u1ee5ng c\u1ee9ng nh\u01b0 g\u1ed7)\u0111au r\u1ea5t nhi\u1ec1u , C\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c , Ph\u1ea3n \u1ee9ng th\u00e0nh b\u1ee5ng ho\u1eb7c Ph\u1ea3n \u1ee9ng d\u1ed9i kh\u1eafp b\u1ee5ng<\/p>\n

C\u00f3 c\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c, \u00edt khi g\u1eb7p co c\u1ee9ng th\u1ef1c s\u1ef1 nh\u01b0 vi\u00eam ph\u00fac m\u1ea1c.<\/p>\n

– C\u00f3 th\u1ec3 s\u1edd th\u1ea5y u, d\u1ecb v\u1eadt, b\u00fai giun\u2026<\/p>\n

– Khi ru\u1ed9t \u0111\u00e3 ho\u1ea1i t\u1eed \u00e0 vi\u00eam ph\u00fac m\u1ea1c.<\/p>\n

G\u00f5<\/p>\n

G\u00f5 ( h\u1ea1n ch\u1ebf g\u00f5 ): Vang v\u00f9ng cao \u0111\u1ee5c v\u00f9ng th\u1ea5p<\/p>\n

N\u1ebfu \u00edt d\u1ecbch c\u00f3 th\u1ec3 g\u00f5 \u0111\u1ee5c v\u00f9ng th\u1ea5p, d\u1ecbch l\u01b0\u1ee3ng v\u1eeba g\u00f5 \u0111\u1ee5c h\u00ecnh nan hoa, d\u1ecbch nhi\u1ec1u c\u00f3 th\u1ec3 g\u00f5 \u0111\u1ee5c to\u00e0n b\u1ee5ng.<\/p>\n

G\u00f5 vang v\u00ec c\u00e1c quai ru\u1ed9t gi\u00e3n ch\u01b0\u1edbng \u0111\u1ea7y h\u01a1i.<\/p>\n

Nghe<\/p>\n

\u00c2m ru\u1ed9t ch\u1eadm ph\u00e1t tri\u1ec3n , v\u1ec1 c\u01b0\u1eddng \u0111\u1ed9 v\u00e0 t\u1ea7n s\u1ed1<\/p>\n

Trong c\u01a1n \u0111au nghe tr\u00ean th\u00e0nh b\u1ee5ng th\u1ea5y ti\u1ebfng r\u00e9o c\u1ee7a ru\u1ed9t m\u1ea1nh h\u01a1n, nhi\u1ec1u h\u01a1n v\u00e0 \u00e2m s\u1eafc cao h\u01a1n. Nghe r\u1ea5t c\u1ea7n thi\u1ebft khi c\u1ea7n ph\u00e2n bi\u1ec7t t\u1eafc ru\u1ed9t c\u01a1 h\u1ecdc v\u00e0 t\u1eafc ru\u1ed9t c\u01a1 n\u0103ng<\/p>\n

Th\u0103m TT-A\u0110<\/p>\n

T\u00fai c\u00f9ng Douglas c\u0103ng , \u1ea5n \u0111au<\/p>\n

T\u00fai c\u00f9ng Douglas c\u0103ng \u0111au, \u0111\u00e2y l\u00e0 tri\u1ec7u ch\u1ee9ng r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb.<\/p>\n

Th\u0103m tr\u1ef1c tr\u00e0ng l\u00e0 ph\u01b0\u01a1ng ph\u00e1t t\u1ed1t nh\u1ea5t \u0111\u1ec3 ph\u00e1t hi\u1ec7n kh\u1ed1i ung th\u01b0 tr\u1ef1c tr\u00e0ng \u1edf th\u1ea5p g\u00e2y t\u1eafc ru\u1ed9t.<\/p>\n

CLS<\/p>\n

X-quang<\/p>\n

b\u1ee5ng kh\u00f4ng chu\u1ea9n b\u1ecb<\/p>\n

– H\u00ecnh \u1ea3nh li\u1ec1m h\u01a1i d\u01b0\u1edbi c\u01a1 ho\u00e0nh : th\u1ee7ng t\u1ea1ng r\u1ed7ng<\/p>\n

– C\u00f3 th\u1ec3 th\u1ea5y \u1ed5 b\u1ee5ng m\u1edd , m\u1ea5t kho\u1ea3ng s\u00e1ng 2 b\u00ean th\u00e0nh b\u1ee5ng<\/p>\n

tr\u00e0n m\u00e1u \u1ed5 b\u1ee5ng<\/p>\n

+ T\u1eafc ru\u1ed9t non :c\u00f3 nhi\u1ec1u m\u1ee9c n\u01b0\u1edbc h\u01a1i t\u1eadp trung gi\u1eefa b\u1ee5ng, k\u00edch th\u01b0\u1edbc nh\u1ecf, v\u00f2m th\u1ea5p, ch\u00e2n r\u1ed9ng, th\u00e0nh m\u1ecfng, c\u00f3 h\u00ecnh c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c ngang.<\/p>\n

+ T\u1eafc \u0111\u1ea1i tr\u00e0ng : c\u00f3 \u00edt m\u1ee9c n\u01b0\u1edbc h\u01a1i, k\u00edch th\u01b0\u1edbc l\u1edbn, v\u00f2m cao, ch\u00e2n h\u1eb9p, n\u1eb1m \u1edf r\u00eca \u1ed5 b\u1ee5ng, c\u00f3 c\u00e1c b\u01b0\u1edbu v\u00e0 c\u00e1c r\u00e3nh tr\u00ean b\u1edd ru\u1ed9t.<\/p>\n

+ Trong t\u1eafc ru\u1ed9t c\u01a1 n\u0103ng, c\u1ea3 ru\u1ed9t non v\u00e0 \u0111\u1ea1i tr\u00e0ng \u0111\u1ec1u gi\u00e3n, ch\u1ee9a h\u01a1i l\u00e0 ch\u1ee7 y\u1ebfu, \u00edt khi c\u00f3 m\u1ee9c n\u01b0\u1edbc h\u01a1i.<\/p>\n

Si\u00eau \u00e2m<\/p>\n

C\u00f3 d\u1ecbch trong \u1ed5 b\u1ee5ng , th\u00e0nh ru\u1ed9t d\u00e0y …<\/p>\n

th\u1ea5y d\u1ecbch t\u1ef1 do<\/p>\n

+ C\u00f3 d\u1ea5u hi\u1ec7u m\u00e1y gi\u1eb7t do d\u1ecbch di chuy\u1ec3n t\u1edbi lui trong l\u00f2ng ru\u1ed9t.<\/p>\n

+ Si\u00eau \u00e2m c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n 1 s\u1ed1 nguy\u00ean nh\u00e2n t\u1eafc nh\u01b0 l\u1ed3ng ru\u1ed9t, kh\u1ed1i u, \u00e1p xe trong \u1ed5 b\u1ee5ng\u2026<\/p>\n

Kh\u00e1c<\/p>\n

C\u00f3 th\u1ec3 th\u1ea5y 1 s\u1ed1 nguy\u00ean nh\u00e2n<\/p>\n

CTM : BC t\u0103ng<\/p>\n

R\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i<\/p>\n

Ur\u00ea ,Creatinin c\u00f3 th\u1ec3 t\u0103ng<\/p>\n

Ch\u1ee5p c\u1eaft l\u1edbp: c\u00f3 gi\u00e1 tr\u1ecb th\u1ea5y d\u1ecbch v\u00e0 th\u01b0\u01a1ng t\u1ed5n c\u00e1c t\u1ea1ng<\/p>\n

CTM: H\u1ed3ng c\u1ea7u gi\u1ea3m, Hb gi\u1ea3m, HCt gi\u1ea3m.<\/p>\n

C\u00c2U 26: Tr\u00ecnh b\u00e0y nguy\u00ean nh\u00e2n g\u00e2y t\u1eafc m\u1eadtth\u01b0\u1eddng g\u1eb7p .<\/p>\n

I. NGUY\u00caN NH\u00c2N
\n\u0110\u1ecbnh ngh\u0129a: t\u1eafc m\u1eadt l\u00e0 t\u00ecnh tr\u1ea1ng t\u1eafc \u0111\u01b0\u1eddng b\u00e0i xu\u1ea5t m\u1eadt trong hay ngo\u00e0i gan donhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau.Khi t\u1eafc m\u1eadt, m\u1eadt s\u1ebd ng\u1ea5m v\u00e0o m\u00e1u trong \u0111\u00f3 c\u00f3 bilirubin g\u00e2y v\u00e0ng da v\u00e0 ni\u00eam m\u1ea1c, \u0111\u00e2y l\u00e0 giai \u0111o\u1ea1n r\u1ea5t n\u1eb7ng. T\u1eafc m\u1eadt l\u00e2u ng\u00e0y s\u1ebd d\u1eabn \u0111\u1ebfn x\u01a1 ho\u00e1 kho\u1ea3ng c\u1eeda,vi\u00eam gan, x\u01a1 gan\u2026<\/p>\n

1.Trong gan:
\n+ Vi\u00eam gan do virus, do ho\u00e1 ch\u1ea5t ( thu\u1ed1c, r\u01b0\u1ee3u, ho\u00e1 ch\u1ea5t)
\n+ Ung th\u01b0 gan, X\u01a1 gan nguy\u00ean ph\u00e1t.
\n2. Ngo\u00e0i gan:
\n+ S\u1ecfi \u0111\u01b0\u1eddng m\u1eadt
\n+ U \u0111\u1ea7u t\u1ee5y, u b\u00f3ng Vater,
\n+ Nang \u1ed1ng m\u1eadt ch\u1ee7, giun chui \u1ed1ng m\u1eadt, K \u0111\u01b0\u1eddng m\u1eadt
\n+ T\u1eafc m\u1eadt sau ch\u1ea5n th\u01b0\u01a1ng hay ph\u1eabu thu\u1eadt.
\nII. NGUY\u00caN NH\u00c2N TH\u01af\u1edcNG G\u1eb6P
\n1. S\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7
\n+ Tam ch\u1ee9ng Charcot:\u0110au, S\u1ed1t, V\u00e0ng da v\u00e0 k\u1ebft m\u1ea1c m\u1eaft. C\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y xu\u1ea5t hi\u1ec7n v\u00e0 bi\u1ebfn m\u1ea5t theo tr\u00ecnh t\u1ef1, l\u1eadp \u0111i l\u1eadp l\u1ea1i
\n+ C\u00f3 th\u1ec3 th\u1ea5y c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 : Th\u1ea5m m\u1eadt ph\u00fac m\u1ea1c, Vi\u00eam ph\u00fac m\u1ea1c m\u1eadt.
\n+ XN: Bilirubin m\u00e1u t\u0103ng
\n+ Si\u00eau \u00e2m c\u00f3 th\u1ec3 th\u1ea5y s\u1ecfi.
\n+ CT scanner r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n.
\n2. U \u0111\u1ea7u t\u1ee5y hay u b\u00f3ng Vater:
\n+ \u0110au \u00e2m \u0129 m\u01a1 h\u1ed3, kh\u00f4ng s\u1ed1t ho\u1eb7c s\u1ed1t mu\u1ed9n, v\u00e0ng da li\u00ean t\u1ee5c ng\u00e0y c\u00e0ng t\u0103ng
\n+ XN: Bilirubin m\u00e1u t\u0103ng, Phosphat ki\u1ec1m t\u0103ng.
\n+ Si\u00eau \u00e2m: th\u1ea5y \u0111\u01b0\u1eddng m\u1eadt gi\u00e3n, c\u00f3 th\u1ec3 th\u1ea5y kh\u1ed1i u.
\n+ CT Scanner: c\u00f3 th\u1ec3 th\u1ea5y kh\u1ed1i u.
\n3. U \u0111\u01b0\u1eddng m\u1eadt
\n+ \u0110au \u00edt, s\u1ed1t \u00edt, v\u00e0ng da li\u00ean t\u1ee5c ng\u00e0y c\u00e0ng t\u0103ng
\n+ XN: Bilirubin m\u00e1u t\u0103ng
\n+ Si\u00eau \u00e2m c\u00f3 th\u1ec3 th\u1ea5y u.
\n+ Ch\u1ee5p ERCP: th\u1ea5y nham nh\u1edf n\u01a1i t\u1ed5n th\u01b0\u01a1ng.
\n+ CT Scanner th\u1ea5y r\u00f5 t\u1ed5n th\u01b0\u01a1ng.
\n4. Nang \u0111\u01b0\u1eddng m\u1eadt
\n+ S\u1ed1t, \u0111au \u00e2m \u0129 v\u00e0ng da kh\u00f4ng r\u00f5.
\n+ S\u1edd b\u1ee5ng c\u00f3 th\u1ec3 th\u1ea5y kh\u1ed1i u.
\n+ XN: bilirubin m\u00e1u t\u0103ng, bilirubin tr\u1ef1c ti\u1ebfp t\u0103ng.
\n+ Si\u00eau \u00e2m c\u00f3 th\u1ec3 th\u1ea5y nang \u1ed1ng m\u1eadt ch\u1ee7.
\n+ CT Scanner th\u1ea5y r\u00f5 t\u1ed5n th\u01b0\u01a1ng
\n5. Giun chui \u1ed1ng m\u1eadt
\n+ \u0110au d\u1eef d\u1ed9i, s\u1ed1t, v\u00e0ng da \u00edt g\u1eb7p
\n+ Si\u00eau \u00e2m c\u00f3 th\u1ec3 th\u1ea5y h\u00ecnh \u1ea3nh giun trong \u1ed1ng m\u1eadt.
\n+ N\u1ed9i soi t\u00e1 tr\u00e0ng g\u1eafp giun \u0111ang l\u00e0 bi\u1ec7n ph\u00e1p \u01b0a chu\u1ed9ng hi\u1ec7n nay
\nC\u00c2U 25: Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng t\u1eafc m\u1eadt<\/p>\n

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

-\u0110au b\u1ee5ng: \u0111au th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf h\u1ea1 s\u01b0\u1eddn ph\u1ea3i hay th\u01b0\u1ee3ng v\u1ecb. M\u1ee9c \u0111\u1ed9 \u0111au t\u00f9y v\u00e0o \u1ed1ng m\u1eadt ch\u1ee7 hay giun chui \u0111\u01b0\u1eddng m\u1eadt s\u1ebd xu\u1ea5t hi\u1ec7n c\u01a1n \u0111au qu\u1eb7n gan. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00e1c l\u1ea1i \u0111au \u00edt, \u00e2m \u0129 m\u01a1 h\u1ed3. \u0110au c\u00f3 th\u1ec3 li\u00ean quan t\u1edbi b\u1eefa \u0103n, \u0111\u1eb7c bi\u1ec7t l\u00e0 th\u1ee9c \u0103n nhi\u1ec1u d\u1ea7u m\u1ee1.<\/p>\n

-S\u1ed1t: c\u00f3 th\u1ec3 sau \u0111au, c\u00f3 th\u1ec3 s\u1ed1t cao r\u00e9t run t\u1eebng c\u01a1n hay li\u00ean t\u1ee5c. D\u1ea5u hi\u1ec7u n\u00e0y kh\u00f4ng r\u00f5 \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m mi\u1ec5n d\u1ecbch, ti\u1ec3u \u0111\u01b0\u1eddng ho\u1eb7c \u0111\u00e3 d\u00f9ng kh\u00e1ng sinh.<\/p>\n

-V\u00e0ng da: c\u00f3 th\u1ec3 th\u1ea5y v\u00e0ng da t\u1eebng \u0111\u1ee3t(s\u1ecfi m\u1eadt) hay v\u00e0ng da li\u00ean t\u1ee5c ng\u00e0y c\u00e0ng t\u0103ng d\u1ea7n(u \u0111\u01b0\u1eddng m\u1eadt, u \u0111\u1ea7u tu\u1ef5, u b\u00f3ng Vater).<\/p>\n

-N\u01b0\u1edbc ti\u1ec3u s\u1eabm m\u00e0u<\/p>\n

-Ph\u00e2n b\u1ea1c m\u00e0u, c\u00f3 th\u1ec3 tr\u1eafng nh\u01b0 ph\u00e2n c\u00f2 khi t\u1eafc m\u1eadt ho\u00e0n to\u00e0n, th\u01b0\u1eddng g\u1eb7p trong u \u0111\u1ea7u tu\u1ef5 hay u b\u00f3ng Vater.<\/p>\n

-Ng\u1ee9a: do acide ng\u1ea5m v\u00e0o m\u00e1u k\u00edch th\u00edch c\u00e1c \u0111\u1ea7u t\u1eadn c\u00f9ng c\u1ee7a c\u00e1c d\u00e2y th\u1ea7n kinh d\u01b0\u1edbi da.<\/p>\n

-N\u00f4n ra m\u00e1u: g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n gi\u00e3n v\u1ee1 t\u0129nh m\u1ea1ch th\u1ef1c qu\u1ea3n do t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda.<\/p>\n

-T\u00ecnh t\u1ea1ng t\u00e2m th\u1ea7n c\u1ee7a b\u1ec7nh nh\u00e2n bi\u1ec3u hi\u1ec7n d\u1ea5u hi\u1ec7u n\u00e3o gan.<\/p>\n

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

2.1. To\u00e0n th\u00e2n<\/p>\n

-V\u00e0ngda hay v\u00e0ng ni\u00eam m\u1ea1c m\u1eaft ( khi bilirubin >20mg\/dl): kh\u00e1m d\u01b0\u1edbi \u00e1nh s\u00e1ng t\u1ef1 nhi\u00ean, \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 v\u00e0ng, m\u00e0u s\u1eafc v\u00e0ng ( v\u00e0ng t\u01b0\u01a1i, x\u1ea1m \u0111en\u2026), v\u00e0ng t\u1eebng \u0111\u1ee3t hay v\u00e0ng da ng\u00e0y c\u00e0ng t\u0103ng d\u1ea7n.<\/p>\n

-S\u1ed1t cao r\u00e9t run li\u00ean t\u1ee5c hay dao \u0111\u1ed9ng, c\u00f3 tr\u01b0\u1edbc hay sau<\/p>\n

-D\u1ea5u xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da khi c\u00f3 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u do suy gan hay t\u1eafc m\u1eadt k\u00e9o d\u00e0i.<\/p>\n

-D\u1ea5u sao m\u1ea1ch : khi c\u00f3 suy gan.<\/p>\n

2.2. Kh\u00e1m b\u1ee5ng<\/p>\n

-B\u1ee5ng b\u00e1ng: nh\u00ecn b\u1ee5ng b\u00e8 ra hai b\u00ean, c\u00f3 d\u1ea5u hi\u1ec7u s\u00f3ng v\u1ed7. R\u1ed1n l\u1ed3i.<\/p>\n

-Tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7 hay tu\u1ea7n ho\u00e0n ph\u1ee5: do t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda. Nh\u00ecn th\u1ea5y c\u00e1c t\u0129nh m\u1ea1ch n\u1ed7i d\u01b0\u1edbi da quanh r\u1ed1n ho\u1eb7c hai b\u00ean h\u00f4ng.<\/p>\n

2.3. Kh\u00e1m gan m\u1eadt<\/p>\n

-Kh\u00e1m gan to: s\u1edd x\u00e1c \u0111\u1ecbnh b\u1edd d\u01b0\u1edbi c\u1ee7a gan khi gan to( b\u00ecnh th\u01b0\u1eddng kh\u00f4ng s\u1edd th\u1ea5y), x\u00e1c \u0111\u1ecbnh b\u1edd s\u1eafc hay t\u00f9, m\u00f4 t\u1ea3 k\u00edch th\u01b0\u1edbc m\u1eadt \u0111\u1ed9, b\u1ec1 m\u1eb7t gan. G\u00f5 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh b\u1edd tr\u00ean gan, b\u00ecnh th\u01b0\u1eddng \u0111\u00f3 l\u00e0 \u0111\u01b0\u1eddng v\u00f2ng cung theo \u0111\u01b0\u1eddng n\u00fam v\u00fa khoang li\u00ean s\u01b0\u1eddn 5, \u0111\u01b0\u1eddng n\u00e1ch gi\u1eefa khoang li\u00ean s\u01b0\u1eddn 7, n\u00e1ch sau khoang li\u00ean s\u01b0\u1eddn 9.<\/p>\n

-\u1ea4n k\u1ebb s\u01b0\u1eddn (+), rung gan (+) khi \u00e1p xe gan.<\/p>\n

-T\u00fai m\u1eadt to: d\u00f9ng hai tay s\u1edd n\u1eafn, b\u00ecnh th\u01b0\u1eddng kh\u00f4ng s\u1edd \u0111\u01b0\u1ee3c t\u00fai m\u1eadt. khi t\u00fai m\u1eadt to c\u00f3 th\u1ec3 s\u1edd th\u1ea5y m\u1ed9t kh\u1ed1i \u0111\u00e0n h\u1ed3i( vi\u00eam t\u00fai m\u1eadt) hay c\u1ee9ng( u t\u00fai m\u1eadt). T\u00ecm c\u00e1c \u0111i\u1ec3m \u0111au t\u00fai m\u1eadt( \u0111i\u1ec3m m\u0169i \u1ee9c, \u0111i\u1ec3m Murphy). L\u00e0m nghi\u1ec7m ph\u00e1p Murphy khi vi\u00eam t\u00fai m\u1eadt kh\u00f4ng to.<\/p>\n

C\u00e2u 8: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng th\u01b0\u1eddng g\u1eb7p c\u1ee7a kh\u00e1m h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng<\/p>\n

M\u1ed7i v\u1ecb tr\u00ed c\u1ee7a v\u00f9ng h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng c\u00f3 nh\u1eefng tri\u1ec7u ch\u1ee9ng ri\u00eang bi\u1ec7t nh\u01b0ng c\u0169ng c\u00f3tri\u1ec7u ch\u1ee9ng chung cho m\u1ecdi v\u1ecb tr\u00ed.<\/p>\n

1. \u1ede l\u1ed7 h\u1eadu m\u00f4n v\u00e0 v\u00f9ng chung quanh.
\n– Ng\u1ee9a ng\u00e1y: th\u00f4ng th\u01b0\u1eddng do vi\u00eam nhi\u1ec5m
\n– \u0110au nh\u1ee9c nh\u1ed1i \u1edf m\u1ed9t \u0111i\u1ec3m: b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea3m gi\u00e1c nh\u01b0 c\u00f3 m\u1ed9t u nh\u1ecf c\u00f2m c\u1ed9m, k\u00e8mtheo c\u00f3 r\u1ec9 m\u1ed9t ch\u00fat n\u01b0\u1edbc v\u00e0ng b\u1ea9n hay d\u00ednh m\u1ed9t \u00edt m\u00e1u v\u00e0o qu\u1ea7n l\u00f3t.
\n2. \u1ede \u1ed1ng h\u1eadu m\u00f4n.
\n– C\u1ea3m gi\u00e1c bu\u1ed1t m\u00f3t.
\n– Khi \u0111\u1ea1i ti\u1ec7n ph\u00e2n qua h\u1eadu m\u00f4n l\u00e0m b\u1ec7nh nh\u00e2n r\u1ea5t \u0111au. Sau khi \u0111\u1ea1i ti\u1ec7n, \u0111au d\u1ecbu \u0111ich\u1ed1c l\u00e1t r\u1ed3i l\u1ea1i \u0111au tr\u1edf l\u1ea1i, \u0111au k\u00e9o d\u00e0i nhi\u1ec1u gi\u1edd. C\u00f3 khi v\u00ec qu\u00e1 \u0111au, b\u1ec7nh nh\u00e2n kh\u00f4ngd\u00e1m \u0103n nhi\u1ec1u, s\u1ee3 ph\u1ea3i \u0111\u1ea1i ti\u1ec7n nhi\u1ec1u. Nguy\u00ean nh\u00e2n c\u1ee7a \u0111au l\u00e0 co c\u1ee9ng c\u01a1 th\u1eaft, trongb\u1ec7nh n\u1ee9t h\u1eadu m\u00f4n.
\n3. \u1ede b\u00f3ng tr\u1ef1c tr\u00e0ng
\n– \u0110au m\u00f3t \u0111\u1ea1i ti\u1ec7n.
\n– M\u00f3t r\u1eb7n, ti\u00eau nhi\u1ec1u l\u1ea7n nh\u01b0ng kh\u00f4ng ra ph\u00e2n m\u00e0 ra to\u00e0n ch\u1ea5t nh\u1ea7y do vi\u00eam ni\u00eam m\u1ea1ctr\u1ef1c tr\u00e0ng, hay g\u1eb7p khi c\u00f3 \u00e1p xe \u1edf t\u00fai c\u00f9ng Douglas.
\n4. Nh\u1eefng r\u1ed1i lo\u1ea1n do nh\u1eefng th\u01b0\u01a1ng t\u1ed5n kh\u00f4ng khu tr\u00fa
\nv – Ti\u00eau ch\u1ea3y v\u00e0 t\u00e1o b\u00f3n.
\nTi\u00eau ch\u1ea3y v\u00e0 t\u00e1o b\u00f3n l\u00e0 nh\u1eefng tri\u1ec7u ch\u1ee9ng c\u1ee7a c\u00e1c b\u1ec7nh to\u00e0n th\u00e2n nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3do c\u00e1c th\u01b0\u01a1ng t\u1ed5n \u1edf v\u00f9ng h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng.
\nv – Ph\u00e2n nh\u1ecf, d\u1eb9t: Ph\u00e2n v\u1eabn \u0111\u00f3ng khu\u00f4n nh\u01b0ng nh\u1ecf v\u00e0 d\u1eb9t l\u1ea1i nh\u01b0 m\u1ed9t d\u1ea3i b\u0103ng, k\u00e8mtheo kh\u00f3 ti\u00eau. G\u1eb7p trong c\u00e1c th\u01b0\u01a1ng t\u1ed5n l\u00e0m ch\u00edt h\u1eb9p l\u00f2ng h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng \u0111\u1eb7c bi\u1ec7tl\u00e0 ung th\u01b0 tr\u1ef1c tr\u00e0ng.
\nv – Ch\u1ea3y m\u00e1u do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau.
\nM\u00e1u d\u00ednh v\u00e0o qu\u1ea7n l\u00f3t: m\u00e1u t\u1eeb c\u00e1c b\u00fai tr\u0129, t\u1eeb c\u00e1c ch\u1ed7 lo\u00e9t hay t\u1eeb c\u00e1c \u1ee5 \u1edf r\u00eca h\u1eadum\u00f4n.
\n\u00b7 M\u00e1u d\u00ednh v\u00e0o ph\u00e2n: Ch\u1ee9ng t\u1ecf m\u1ed9t th\u01b0\u01a1ng t\u1ed5n \u1edf th\u1ea5p, n\u01a1i m\u00e0 c\u1ee5c ph\u00e2n \u0111\u00e3 h\u00ecnhth\u00e0nh. M\u00e1u t\u1eeb c\u00e1c polyp, t\u1eeb c\u00e1c u hay t\u1eeb c\u00e1c ch\u1ed7 n\u1ee9t c\u1ee7a h\u1eadu m\u00f4n.
\n\u00b7 M\u00e1u ra sau ph\u00e2n: l\u00e0 m\u00e1u t\u1eeb c\u00e1c b\u00fai tr\u0129 trong. Sau khi \u0111\u1ea1i ti\u1ec7n, gi\u1ea5y ch\u00f9i d\u00ednh ph\u00e2nhay c\u00f3 khi m\u00e1u ch\u1ea3y th\u00e0nh tia nh\u01b0 c\u1eaft ti\u1ebft g\u00e0.
\n\u00b7 Ph\u00e2n to\u00e0n m\u00e1u: v\u1edbi s\u1ed1 l\u01b0\u1ee3ng nhi\u1ec1u b\u1eaft \u0111\u1ea7u v\u00e0 k\u1ebft th\u00fac \u0111\u1ed9t ng\u1ed9t, g\u1eb7p trong b\u1ec7nhvi\u00eam lo\u00e9t tr\u1ef1c tr\u00e0ng-\u0111\u1ea1i tr\u00e0ng ch\u1ea3y m\u00e1u, b\u1ec7nh \u0111a polyp \u1edf tr\u1ef1c tr\u00e0ng – \u0111\u1ea1itr\u00e0ng, ung th\u01b0 \u0111\u1ea1i tr\u00e0ng.
\nM\u00e1u ch\u1ea3y t\u1eeb c\u00e1c th\u01b0\u01a1ng t\u1ed5n \u1edf h\u1eadu m\u00f4n – tr\u1ef1c tr\u00e0ng c\u00f3 m\u00e0u \u0111\u1ecf, kh\u00e1c v\u1edbi m\u00e1u ch\u1ea3y t\u1eeb ru\u1ed9tnon, t\u1eeb t\u00e1 tr\u00e0ng hay d\u1ea1 d\u00e0y c\u00f3 m\u00e0u \u0111en do b\u1ecb ph\u00e2n hu\u1ef7.
\nTh\u1eadt ra h\u00ecnh th\u1ee9c ch\u1ea3y m\u00e1u, t\u00ednh ch\u1ea5t m\u00e1u ch\u1ea3y v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng kh\u00e1c ch\u1ec9 c\u00f3t\u00e1c d\u1ee5ng g\u1ee3i \u00fd, kh\u00f4ng th\u1ec3 c\u0103n c\u1ee9 v\u00e0o \u0111\u1ea5y \u00e0m ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh. Mu\u1ed1n c\u00f3 ch\u1ea9n \u0111o\u00e1nch\u1eafc ch\u1eafn ph\u1ea3i th\u0103m kh\u00e1m h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng m\u1ed9t c\u00e1ch h\u1ec7 th\u1ed1ng.
\nM\u1ecdi \u0111\u1ed9ng t\u00e1c th\u0103m kh\u00e1m v\u00f9ng h\u1eadu m\u00f4n \u0111\u1ec1u l\u00e0m cho b\u1ec7nh nh\u00e2n ng\u01b0\u1ee3ng ngh\u1ecbu, th\u1eb9nth\u00f9ng nh\u1ea5t l\u00e0 \u0111\u1ed1i v\u1edbi ph\u1ee5 n\u1eef. V\u00ec v\u1eady bao gi\u1edd c\u0169ng ph\u1ea3i k\u00edn \u0111\u00e1o, c\u00f3 bu\u1ed3ng ri\u00eang, c\u00f3 r\u00e8m,c\u00f3 kh\u0103n che v\u00e0 h\u1ea1n ch\u1ebf s\u1ed1 nh\u00e2n vi\u00ean.<\/p>\n

C\u00e2u 9: Tr\u00ecnh b\u00e0y c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 khi kh\u00e1m h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng?<\/p>\n

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

+ T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n: BN n\u1eb1m ch\u1ed5ng m\u00f4ng tr\u00ean b\u00e0n kh\u00e1m, m\u00f4ng cao 2 \u0111\u1ea7u g\u1ed1i v\u00e0 2 khu\u1ef7u tay t\u1ef3 tr\u00ean gi\u01b0\u1eddng v\u00e0 \u0111\u1ea7u g\u1ee5c th\u1ea5p, k\u00e9o qu\u1ea7n xu\u1ed1ng \u0111\u1ec3 l\u1ed9 ho\u00e0n to\u00e0n 2 m\u00f4ng.<\/p>\n

+ Th\u1ea7y thu\u1ed1c \u0111\u1ee9ng 2 b\u00e0n tay \u00e1p l\u00ean 2 m\u00f4ng BN , 2 ng\u00f3n c\u00e1i \u0111\u1eb7t s\u00e1t g\u1ea7n l\u1ed7 h\u1eadu m\u00f4n banh r\u1ed9ng 2 m\u00f4ng sang 2 b\u00ean \u0111\u1ec3 nh\u00ecn r\u00f5 l\u1ed7 h\u1eadu m\u00f4n v\u00e0 v\u00f9ng chung quanh.<\/p>\n

+ B\u00ecnh th\u01b0\u1eddng l\u1ed7 h\u1eadu m\u00f4n \u0111\u00f3ng k\u00edn, c\u00f3 c\u00e1c n\u1ebfp nh\u0103n t\u1eeb l\u1ed7 h\u1eadu m\u00f4n t\u1ecfa ra xung quanh theo h\u00ecnh nan hoa c\u00f3 th\u1ec3 kh\u00e1m \u1edf c\u00e1c t\u01b0 th\u1ebf kh\u00e1c nhau nh\u01b0 n\u1eb1m nghi\u00ean b\u00ean T v\u00e0 m\u00f4ng s\u00e1t ra th\u00e0nh b\u00e0n kh\u00e1m hay t\u01b0 th\u1ebf s\u1ea3n ph\u1ee5 khoa<\/p>\n

* Nh\u1eefng th\u01b0\u01a1ng t\u1ed5n c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y.<\/p>\n

– Sa tr\u1ef1c tr\u00e0ng: M\u1ed9t kh\u1ed1i ni\u00eam m\u1ea1c (d\u00e0i 2- 10 cm), m\u00e0u h\u1ed3ng h\u00ecnh tr\u1ee5, hay h\u00ecnh n\u00f3n c\u1ee5t v\u1edbi 1 l\u1ed7 \u1edf gi\u1eefa \u0111\u1ec9nh, m\u1eb7t kh\u1ed1i c\u00f3 nh\u1eefng n\u1ebfp ni\u00eam m\u1ea1c h\u00ecnh v\u00f2ng tr\u00f2n \u0111\u1ed3ng t\u00e2m<\/p>\n

– Tr\u0129: T\u1eeb trong l\u1ed7 h\u1eadu m\u00f4n l\u00f2i ra nh\u1eefng b\u00fai nh\u1ecf, ph\u1ed3ng m\u1ed9ng, m\u00e0u t\u00edm \u0111\u1ecf, th\u01b0\u1eddng c\u00f3 ba b\u00fai ri\u00eang bi\u1ec7t n\u1eb1m \u1edf v\u1ecb tr\u00ed 4g, 7g, 11g,c\u00e1c b\u00fai n\u00e0y c\u00f3 th\u1ec3 to h\u01a1n v\u00e0 li\u00ean k\u1ebft v\u1edbi nhau t\u1ea1o th\u00e0nh v\u00f2ng tr\u00f2n<\/p>\n

– \u00c1p xe c\u1ea1nh h\u1eadu m\u00f4n: Chung quanh h\u1eadu m\u00f4n, \u1edf g\u1ea7n hay xa l\u1ed7 h\u1eadu m\u00f4n c\u00f3 m\u1ed9t ch\u1ed7 ph\u1ed3ng l\u00ean t\u1ea5y \u0111\u1ecf, s\u01b0ng n\u1ec1, \u0111au, n\u1ebfu n\u1eb1m s\u00e1t l\u1ed7 h\u1eadu m\u00f4n l\u00e0m h\u1eadu m\u00f4n m\u00e1t c\u00e1c n\u1ebfp nh\u0103n<\/p>\n

– R\u00f2 h\u1eadu m\u00f4n: Chung quanh, sat ngay hay c\u00e1ch xa l\u1ed7 h\u1eadu m\u00f4n 1-2 cm c\u00f3 m\u1ed9t m\u1ee5n nh\u1ecf l\u1ed3i l\u00ean, gi\u1eefa m\u1ee5n c\u00f3 m\u1ed9t l\u1ed7, n\u1eb7n c\u00f3 th\u1ec3 th\u1ea5y 1 gi\u1ecdt n\u01b0\u1edbc v\u00e0ng hay 1 gi\u1ecdt m\u0169 ch\u1ea3y ra, l\u1ed7 c\u00f3 th\u1ec3 b\u1ecbt k\u00edn b\u1edfi 1 v\u1ea9y<\/p>\n

– N\u1ee9t h\u1eadu m\u00f4n: Banh r\u1ed9ng hai m\u00f4ng c\u00f3 th\u1ec3 th\u1ea5y \u1edf s\u00e2u trong \u1ed1ng h\u1eadu m\u00f4n 1 ch\u1ed7 m\u1ea5t ni\u00eam m\u1ea1c, l\u1ecfm xu\u1ed1ng b\u1eb1ng h\u1ea1t g\u1ea1o h\u00ecnh tr\u00e1i v\u1ee3t th\u01b0\u1eddng n\u1eb1m \u1edf v\u1ecb tr\u00ed 6 gi\u1edd. Nhi\u1ec1u khi kh\u00f4ng th\u1ec3 banh r\u1ed9ng h\u1eadu m\u00f4n \u0111\u1ec3 nh\u00ecn r\u00f5 th\u01b0\u01a1ng t\u1ed5n v\u00ec BN r\u1ea5t \u0111au.<\/p>\n

– Ung th\u01b0 h\u1eadu m\u00f4n: M\u1ed9t u s\u00f9i, nh\u1ecf hay to, l\u1ee3t m\u00e0u hay 1 lo\u00e9t n\u1ec1n c\u1ee9ng, \u0111\u1ee5ng v\u00e0o d\u1ec5 ch\u1ea3y m\u00e1u. Nhi\u1ec1u u s\u00f9i k\u00edch th\u01b0\u1edbc l\u1edbn nh\u1ecf kh\u00f4ng \u0111i\u1ec1u c\u00f3 th\u1ec3 c\u00f3 1 b\u00ean hay c\u1ea3 v\u00f2ng h\u1eadu m\u00f4n<\/p>\n

II. Th\u0103m tr\u1ef1c tr\u00e0ng :<\/p>\n

D\u00f9ng ng\u00f3n tr\u1ecf \u0111\u01b0a qua l\u1ed7 h\u1eadu m\u00f4n v\u00e0o trong l\u00f2ng \u1ed1ng h\u1eadu m\u00f4n v\u00e0 ph\u1ea7n d\u01b0\u1edbi c\u1ee7a b\u00f3ngtr\u1ef1c tr\u00e0ng. Ng\u00f3n tay c\u00f3 th\u1ec3 \u0111\u01b0a s\u00e2u 8cm. Ng\u00f3n tay \u0111\u01b0\u1ee3c mang g\u0103ng b\u00e0n tay hay g\u0103ngng\u00f3n tay v\u00e0 \u0111\u01b0\u1ee3c b\u00f4i tr\u01a1n b\u1eb1ng d\u1ea7u.<\/p>\n

Th\u0103m h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng b\u1eb1ng ng\u00f3n tay \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c th\u01b0\u01a1ng t\u1ed5n.\u1ede \u1ed1ng h\u1eadu m\u00f4n v\u00e0 ph\u1ea7n d\u01b0\u1edbi c\u1ee7a b\u00f3ng tr\u1ef1c tr\u00e0ng.\u1ede ngo\u00e0i h\u1eadu m\u00f4n – tr\u1ef1c tr\u00e0ng nh\u01b0ng c\u00f3 li\u00ean quan \u0111\u1ebfn v\u00f9ng n\u00e0y. V\u00e0 trong c\u1ea5p c\u1ee9u \u0111\u1ec3 xem t\u00ecnh tr\u1ea1ng c\u1ee7a t\u00fai c\u00f9ng Douglas.<\/p>\n

1. T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n: C\u00e1c t\u01b0 th\u1ebf th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng l\u00e0.<\/p>\n

– N\u1eb1m nghi\u00eang tr\u00e1i: b\u1ec7nh nh\u00e2n n\u1eb1m nghi\u00eang t\u00e1i, ch\u00e2n ph\u1ea3i \u1edf tr\u00ean co, ch\u00e2n tr\u00e1i \u1edf d\u01b0\u1edbidu\u1ed7i, m\u00f4ng nh\u00f4 ra kh\u1ecfi m\u00e9p gi\u01b0\u1eddng. Th\u1ea7y thu\u1ed1c \u0111\u1ee9ng sau l\u01b0ng b\u1ec7nh nh\u00e2n.<\/p>\n

– N\u1eb1m ng\u1eeda, ch\u00e2n ph\u1ea3i co nh\u1eb9, tay th\u1ea7y thu\u1ed1c \u0111\u1eb7t tr\u00ean hay d\u01b0\u1edbi \u0111\u00f9i BN. t\u01b0 th\u1ebf n\u00e0y th\u01b0\u1eddng d\u00f9ng cho c\u00e1c BN \u0111ang c\u00f3 nh\u1eefng th\u01b0\u01a1ng t\u1ed5n c\u1ea5p t\u00ednh c\u1ee7a \u1ed5 b\u1ee5ng (VPM, \u00e1p xe t\u00fai c\u00f9ng Douglas, t\u1eafc ru\u1ed9t …)<\/p>\n

T\u01b0 th\u1ebf n\u00e0y c\u00f2n cho ph\u00e9p ph\u1ed1i h\u1ee3p ng\u00f3n tay \u1edf tr\u1ef1c tr\u00e0ng v\u00e0 b\u00e0n tay kia \u1edf th\u00e0nh b\u1ee5ng.<\/p>\n

– N\u1eb1m ng\u1eeda, hai ch\u00e2n g\u1ea5p t\u1ed1i \u0111a. Hai b\u00e0n tay b\u1ec7nh nh\u00e2n c\u1ea7m hai \u0111\u1ea7u g\u1ed1i \u00e9p hai \u0111\u00f9i v\u00e0oth\u00e0nh b\u1ee5ng.<\/p>\n

– N\u1eb1m ch\u1ed5ng m\u00f4ng: t\u01b0 th\u1ebf n\u00e0y cho ph\u00e9p quan s\u00e1t k\u1ef9 th\u00e0nh sau v\u00e0 th\u00e0nh tr\u00e1i tr\u1ef1c tr\u00e0ng.\u1edf t\u01b0 th\u1ebf n\u00e0y c\u00e1c t\u1ea1ng \u1edf trong \u1ed5 b\u1ee5ng v\u00e0 c\u00e1c b\u01b0\u1edbu c\u1ee7a tr\u1ef1c tr\u00e0ng b\u1ecb d\u1ed3n l\u00ean ph\u00eda tr\u00ean.<\/p>\n

2. Th\u0103m kh\u00e1m<\/p>\n

Tr\u01b0\u1edbc khi th\u0103m, b\u00e1o cho b\u1ec7nh nh\u00e2n bi\u1ebft, b\u1ea3o b\u1ec7nh nh\u00e2n th\u1edf \u0111\u1ec1u v\u00e0 s\u00e2u. Khi c\u1ea7n c\u00f3 th\u1ec3b\u1ea3o b\u1ec7nh nh\u00e2n th\u00f3t \u0111\u00edt \u0111\u1ec3 ki\u1ec3m tra c\u01a1 th\u1eaft, b\u1ea3o b\u1ec7nh nh\u00e2n r\u1eb7n \u0111\u1ec3 \u0111\u1ea9y c\u00e1c b\u01b0\u1edbu c\u1ee7a tr\u1ef1ctr\u00e0ng xu\u1ed1ng th\u1ea5p h\u01a1n. C\u00f3 nh\u1eefng th\u01b0\u01a1ng t\u1ed5n nh\u01b0 n\u1ee9t h\u1eadu m\u00f4n, c\u01a1 th\u1eaft b\u1ecb co c\u1ee9ng, th\u0103mkh\u00e1m l\u00e0m b\u1ec7nh nh\u00e2n r\u1ea5t \u0111au.<\/p>\n

V\u00ec c\u1ea5u t\u1ea1o c\u1ee7a l\u1ed7 h\u1eadu m\u00f4n l\u00e0 m\u1ed9t khe, \u0111\u01b0\u1eddng k\u00ednh l\u1edbn n\u1eb1m theo chi\u1ec1u d\u1ecdc tr\u01b0\u1edbc sau, chon\u00ean khi cho tay v\u00e0o l\u1ed7 h\u1eadu m\u00f4n ph\u1ea3i \u0111\u1eb7t tay theo chi\u1ec1u \u0111\u00f3. Khi ng\u00f3n tay \u0111\u00e3 n\u1eb1m trongl\u00f2ng h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng th\u00ec xoay ng\u00f3n tay v\u00e0 mi\u1ebft nh\u1eb9 v\u1ec1 hai ph\u00eda theo chi\u1ec1u kim \u0111\u1ed3ngh\u1ed3 v\u00e0 ng\u01b0\u1ee3c l\u1ea1i. Ch\u00fa \u00fd t\u1edbi h\u00f5m tr\u01b0\u1edbc x\u01b0\u01a1ng cung \u1edf th\u00e0nh sau v\u00ec ch\u1ed7 n\u00e0y d\u1ec5 b\u1ecb s\u00f3t khi soi.Sau khi th\u0103m r\u00fat tay ra nh\u00ecn c\u00f3 th\u1ec3 th\u1ea5y m\u00e1u, ch\u1ea5t nh\u00e0y ho\u1eb7c m\u1ee7 d\u00ednh g\u0103ng. D\u00f9ng g\u1ea1cm\u1ec1m lau s\u1ea1ch d\u1ea7u \u1edf h\u1eadu m\u00f4n.<\/p>\n

3. Nh\u1eefng th\u01b0\u01a1ng t\u1ed5n \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n<\/p>\n

B\u00ecnh th\u01b0\u1eddng khi \u0111\u1ea7u ng\u00f3n tay ch\u1ea1m v\u00e0o l\u1ed7 h\u1eadu m\u00f4n, c\u01a1 th\u1eaft th\u00edt ch\u1eb7t l\u1ea1i v\u00e0 sau \u0111\u00f3 ch\u00f9ngra. Khi \u0111\u01b0a tay v\u00e0o trong th\u1ea5y th\u00e0nh tr\u1ef1c tr\u00e0ng m\u1ec1m m\u1ea1i v\u00e0 ni\u00eam m\u1ea1c nh\u1eb5n. Ph\u00eda tr\u01b0\u1edbc \u1edfgi\u1edbi nam l\u00e0 tuy\u1ec1n ti\u1ec1n li\u1ec7t c\u00f3 hai m\u00fai ph\u00e2n c\u00e1ch nhau b\u1eb1ng m\u1ed9t r\u00e3nh d\u1ecdc, \u1edf gi\u1edbi n\u1eef l\u00e0th\u00e2n v\u00e0 c\u1ed5 t\u1eed cung. Ph\u00eda sau l\u00e0 x\u01b0\u01a1ng c\u1ee9ng.<\/p>\n

a. C\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u1ee7a h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng<\/p>\n

Co th\u1eaft h\u1eadu m\u00f4n : b\u1ea3o b\u1ec7nh nh\u00e2n th\u00f3t \u0111\u00edt, n\u1ebfu c\u01a1 th\u1eaft h\u1eadu m\u00f4n c\u00f2n nguy\u00ean ven s\u1ebdb\u00f3p ch\u1eb7t ng\u00f3n tay. M\u1ed9t v\u1ebft th\u01b0\u01a1ng v\u00f9ng \u0111\u00e1y ch\u1eadu c\u00f3 th\u1ec3 c\u1eaft \u0111\u1ee9t m\u1ed9t ph\u1ea7n hay to\u00e0n b\u1ed9 c\u01a1th\u1eaft. Tr\u01b0\u1eddng h\u1ee3p \u00e1p xe t\u00fai c\u00f9ng Douglas, c\u01a1 th\u1eaft gi\u00e3n r\u1ed9ng, co b\u00f3p y\u1ebfu. Ng\u01b0\u1ee3c l\u1ea1i n\u00f3 c\u00f3th\u1ec3 b\u1ecb x\u01a1 c\u1ee9ng m\u1ed9t ph\u1ea7n hay to\u00e0n b\u1ed9 chu vi, th\u01b0\u1eddng g\u1eb7p trong b\u1ec7nh r\u00f2 h\u1eadu m\u00f4n nh\u1ea5t l\u00e0 \u1edfnh\u1eefng b\u1ec7nh nh\u00e2n r\u00f2 h\u1eadu m\u00f4n \u0111\u00e3 \u0111\u01b0\u1ee3c m\u1ed5 nhi\u1ec1u l\u1ea7n.<\/p>\n

Tr\u0129 n\u1ed9i: Khi tay mi\u1ebft nh\u1eb9 \u1ed1ng h\u1eadu m\u00f4n c\u00f3 th\u1ec3 th\u1ea5y c\u00e1i b\u00fai ph\u1ed3ng m\u1ec1m, khi tay \u1ea5n v\u00e0o th\u00ec d\u1eb9t\u0111i; \u1edf c\u00e1c b\u00fai tr\u0129 n\u00e0y c\u00f3 th\u1ec3 c\u00f3 m\u1ed9t v\u00e0i h\u1ea1t nh\u1ecf, c\u1ee9ng l\u00e0 do t\u1eafc m\u1ea1ch, m\u1ed9t bi\u1ebfnch\u1ee9ng th\u01b0\u1eddng g\u1eb7p \u1edf tr\u0129.<\/p>\n

\u00c1p xe c\u01b0\u1edbi ni\u00eam m\u1ea1c: C\u00e1ch l\u1ed7 h\u1eadu m\u00f4n v\u00e0i ba cm s\u1edd th\u1ea5y m\u1ed9t ch\u1ed7 s\u01b0ng ph\u1ed3ng, m\u1ec1m, \u1ea5n r\u1ea5t \u0111au<\/p>\n

Polyp: T\u1eeb th\u00e0nh tr\u1ef1c tr\u00e0ng m\u1ec1m m\u1ea1i m\u1ecdc l\u00ean m\u1ed9t b\u01b0\u1edbu tr\u00f2n m\u1ec1m, nh\u1ecf b\u1eb1ng h\u1ea1t \u0111\u1eadu, h\u1ea1t l\u1ea1c,c\u00f3 khi to b\u1eb1ng qu\u1ea3 t\u00e1o, qu\u1ea3 qu\u00edt, c\u00f3 cu\u1ed1ng r\u00f5 r\u1ec7t hay kh\u00f4ng. Tr\u01b0\u1eddng h\u1ee3p polyp tov\u00e0 c\u00f3 cu\u1ed1ng d\u00e0i c\u00f3 th\u1ec3 t\u1ee5t ra kh\u1ecfi l\u1ed7 h\u1eadu m\u00f4n v\u00e0 n\u1eb1m ph\u00eda ngo\u00e0i.<\/p>\n

Ni\u00eam m\u1ea1c tr\u1ef1c tr\u00e0ng m\u1ea5t nh\u1eb5n: b\u1ec7nh vi\u00eam \u0111\u1ea1i tr\u00e0ng-tr\u1ef1c tr\u00e0ng hay l\u1ea5mt\u1ea5m v\u00f4 v\u00e0nnh\u1eefng h\u1ea1t m\u1ec1m nh\u1ecf trong b\u1ec7nh polyp. C\u1ea3 2 th\u01b0\u01a1ng t\u1ed5n n\u00e0y g\u00e2y ch\u1ea3y m\u00e1ur\u1ea5t nhi\u1ec1u, BN th\u01b0\u1eddng c\u00f3 thi\u1ebfu m\u00e1u n\u1eb7ng.<\/p>\n

M\u1ed9t b\u01b0\u1edbu m\u1ecdc l\u00ean \u1edf th\u00e0nh \u1ed1ng h\u1eadu m\u00f4n hay t\u1eeb th\u00e0nh b\u00f3ng tr\u1ef1c tr\u00e0ng, tr\u00ean m\u1ed9t n\u1ec1nc\u1ee9ng. B\u01b0\u1edbu n\u1eb1m \u1edf b\u1ea5t c\u1ee9 ch\u1ed7 n\u00e0o tr\u00ean chu vi, chi\u1ebfm m\u1ed9t ph\u1ea7n c\u00f3 khi to\u00e0n b\u1ed9 chu vi l\u00e0mcho l\u00f2ng tr\u1ef1c tr\u00e0ng h\u1eb9p l\u1ea1i ch\u1ec9 \u0111\u00fat l\u1ecdt ng\u00f3n tay nh\u1ecf h\u01a1n kh\u00f4ng \u0111\u00fat l\u1ecdt ng\u00f3n tay. M\u1eb7t b\u01b0\u1edbukh\u00f4ng c\u00f3 ni\u00eam m\u1ea1c nh\u1eb5n ph\u1ee7 m\u00e0 s\u1ea7n s\u00f9i nh\u01b0 b\u1eafp c\u1ea3i hoa trong b\u1ec7nh ung th\u01b0. C\u1ea7nx\u00e1c \u0111\u1ecbnh \u0111\u1ed9 l\u1edbn, v\u1ecb tr\u00ed v\u00e0 t\u00ednh di \u0111\u1ed9ng c\u1ee7a n\u00f3. C\u00f3 khi th\u01b0\u01a1ng t\u1ed5n m\u1edbi ch\u1ec9 l\u00e0 m\u1ed9t m\u1ea3ngc\u1ee9ng \u1edf th\u00e0nh tr\u1ef1c tr\u00e0ng.<\/p>\n

Ng\u00f3n tr\u1ecf trong l\u00f2ng tr\u1ef1c tr\u00e0ng ph\u1ed1i h\u1ee3p v\u1edbi ng\u00f3n c\u00e1i \u1edf t\u1ea7ng sinh m\u00f4n x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c\u0111\u01b0\u1eddng \u0111i v\u00e0 t\u00ecnh tr\u1ea1ng c\u1ee7a \u0111\u01b0\u1eddng r\u00f2 h\u1eadu m\u00f4n.<\/p>\n

b. C\u00e1c t\u1ed5n th\u01b0\u01a1ng \u1edf ngo\u00e0i h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng<\/p>\n

– Th\u0103m tr\u1ef1c tr\u00e0ng l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ee7 y\u1ebfu \u0111\u00e1nh gi\u00e1 m\u1eadt \u0111\u1ed9, \u0111\u1ed9 l\u1edbn c\u1ee7a tuy\u1ebfn ti\u1ec1n li\u1ec7t,t\u00fai tinh.<\/p>\n

– Qua th\u00e0nh tr\u01b0\u1edbc tr\u1ef1c tr\u00e0ng bi\u1ebft \u0111\u01b0\u1ee3c t\u01b0 th\u1ebf, \u0111\u1ed9 l\u1edbn v\u00e0 u x\u01a1 \u1edf m\u1eb7t sau t\u1eed cung.<\/p>\n

– Tr\u1ef1c tr\u00e0ng c\u00f3 th\u1ec3 b\u1ecb c\u00e1c b\u01b0\u1edbu \u1edf ti\u1ec3u khung, \u1edf sau ph\u00fac m\u1ea1c \u0111\u1ea9y l\u1ea5n. c\u00e1c b\u01b0\u1edbu \u1edf ngo\u00e0itr\u1ef1c tr\u00e0ng c\u00f3 th\u1ec3 \u0111\u1ea9y th\u00e0nh tr\u1ef1c tr\u00e0ng nh\u00f4 v\u00e0o trong l\u00f2ng b\u00f3ng tr\u1ef1c tr\u00e0ng nh\u01b0ng kh\u00f4ng\u1ea3nh h\u01b0\u1edfng t\u1edbi ni\u00eam m\u1ea1c, ni\u00eam m\u1ea1c v\u1eabn nh\u1eb5n, tr\u01a1n.<\/p>\n

c. Trong c\u1ea5p c\u1ee9u<\/p>\n

– Th\u0103m tr\u1ef1c tr\u00e0ng ch\u1ec9 l\u00e0 m\u1ed9t trong nhi\u1ec1u kh\u00e2u th\u0103m kh\u00e1m nh\u01b0ng c\u00f3 th\u1ec3 giup \u00edch nhi\u1ec1u,c\u00f3 khi n\u00f3 cho bi\u1ebft nh\u1eefng tri\u1ec7u ch\u1ee9ng c\u00f3 t\u00ednh ch\u1ea5t quy\u1ebft \u0111\u1ecbnh trong ch\u1ea9n \u0111o\u00e1n.<\/p>\n

– \u1ea4n v\u00e0o th\u00e0nh tr\u01b0\u1edbc \u1edf tr\u00ean cao t\u01b0\u01a1ng \u1ee9ng v\u1edbi t\u00fai c\u00f9ng Douglas, b\u1ec7nh nh\u00e2n \u0111au nh\u00f3i(ti\u1ebfng k\u00eau Douglas), ch\u1ee9ng t\u1ecf c\u00f3 m\u1ee7, m\u00e1u \u0111\u1ecdng \u1edf t\u00fai c\u00f9ng Douglas.<\/p>\n

– Vi\u00eam ru\u1ed9t th\u1eeba th\u1ec3 n\u1eb1m th\u1ea5p trong ti\u1ebbu khung \u0111au \u1edf th\u00e0nh ph\u1ea3i tr\u1ef1c tr\u00e0ng.<\/p>\n

– Trong \u00e1p xe t\u00fai c\u00f9ng Douglas th\u1ea5y c\u01a1 th\u1eaft h\u1eadu m\u00f4n do\u00e3ng r\u1ed9ng, co b\u00f3p y\u1ebfu, t\u00fai c\u00f9ngDouglas ph\u1ed3ng, m\u1ec1m, \u1ea5n \u0111au, khi r\u00fat tay ra c\u00f3 ch\u1ea5t nh\u1ea7y d\u00ednh g\u0103ng.<\/p>\n

– Trong t\u1eafc ru\u1ed9t th\u1ea5y b\u00f3ng tr\u1ef1c tr\u00e0ng r\u1ed7ng. N\u1ebfu t\u1eafc ru\u1ed9t do ung th\u01b0 tr\u1ef1c tr\u00e0ng c\u00f3 th\u1ec3 s\u1eddth\u1ea5y kh\u1ed1i u s\u1ea7n s\u00f9i.<\/p>\n

C\u00e2u 10:Tr\u00ecnh b\u00e0y c\u1eadn l\u00e2m s\u00e0ng c\u1ea7n thi\u1ebft khi kh\u00e1m h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng<\/p>\n

I.Soi h\u1eadu m\u00f4n v\u00e0 soi tr\u1ef1c tr\u00e0ng :<\/p>\n

Th\u0103m b\u1eb1ng tay ch\u1ec9 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c nh\u1eefng th\u01b0\u01a1ng t\u1ed5n c\u1ee7a h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng \u1edf c\u00e1ch l\u1ed7h\u1eadu m\u00f4n kh\u00f4ng qu\u00e1 8cm. v\u00e0 ngay trong \u0111o\u1ea1n th\u1ea5p n\u00e0y c\u0169ng c\u00f3 nh\u1eefng th\u01b0\u01a1ng t\u1ed5n m\u00e0ng\u00f3n tay kh\u00f4ng nh\u1eadn bi\u1ebft \u0111\u1ef1oc. V\u00ec v\u1eady trong b\u1ec7nh l\u00fd c\u1ee7a h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng, soi h\u1eadum\u00f4n v\u00e0 soi tr\u1ef1c tr\u00e0ng \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng l\u00e0 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n r\u1ea5t c\u1ea7n thi\u1ebft.<\/p>\n

Ngo\u00e0i ra qua soi ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 l\u00e0m sinh thi\u1ebft ch\u1ea9n \u0111o\u00e1n ho\u1eb7c c\u00f3 khi \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

1. Chu\u1ea9n b\u1ecb b\u1ec7nh nh\u00e2n<\/p>\n

\u0110\u1ea1i tr\u00e0ng v\u00e0 tr\u1ef1c tr\u00e0ng ph\u1ea3i \u0111\u01b0\u1ee3c l\u00e0m s\u1ea1ch. V\u00ec n\u1ebfu kh\u00f4ng ph\u00e2n s\u1ebd che l\u1ea5p th\u01b0\u01a1ng \u1ed5n, b\u1ecbtk\u00edn \u0111\u1ea7u \u1ed1ng n\u1ed9i soi. Ph\u00e2n lo\u00e3ng ch\u1ea3y d\u1ea7m d\u1ec1 l\u00e0m b\u1ea9n b\u1ec7nh nh\u00e2n v\u00e0 th\u1ea7y thu\u1ed1c.<\/p>\n

L\u00e0m s\u1ea1ch \u0111\u1ea1i tr\u00e0ng b\u1eb1ng th\u1ee5t th\u00e1o. b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u1ee5t th\u00e1o \u1edf nh\u00e0 hay \u1edf b\u1ec7nh vi\u1ec7n. C\u00e1chth\u1ee5t th\u00e1o th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng l\u00e0: t\u1ed1i h\u00f4m tr\u01b0\u1edbc th\u1ee5t th\u00e1o v\u1edbi 1,5-2 l\u00edt n\u01b0\u1edbc, s\u00e1ng s\u1edbm khiv\u1eeba ng\u1ee7 d\u1eady cho 2 th\u00eca c\u00e0 ph\u00ea c\u1ed3n paregoric. n\u1ebfu soi v\u00e0o bu\u1ed5i chi\u1ec1u th\u00ec s\u00e1ng ng\u00e0y soi n\u00eanth\u1ee5t th\u00e1o m\u1ed9t l\u1ea7n n\u1eefa v\u00e0 u\u1ed1ng c\u1ed3n paragoric v\u00e0o l\u00fac 11 gi\u1edd. \u0110i\u1ec1u c\u1ea7n ch\u00fa \u00fd l\u00e0 ch\u1ec9 soi saukhi th\u1ee5t th\u00e1o ch\u1ee9ng 4 gi\u1edd. Sau th\u1ee5t , ru\u1ed9t t\u0103ng co b\u00f3p s\u1ebd t\u1ed1ng ph\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c l\u00e0m lo\u00e3ng t\u1eebtr\u00ean cao xu\u1ed1ng tr\u1ef1c tr\u00e0ng, n\u1ebfu soi qu\u00e1 s\u1edbm s\u1ebd ch\u01b0a \u0111\u1ee7 th\u1eddi gian \u0111\u1ec3 t\u1ed1ng ph\u00e2n ra h\u1ebft.<\/p>\n

Soi h\u1eadu m\u00f4n – tr\u1ef1c tr\u00e0ng- \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng th\u01b0\u1eddng kh\u00f4ng l\u00e0m b\u1ec7nh nh\u00e2n \u0111au \u0111\u1edbnnh\u01b0ng l\u00e0m b\u1ec7nh nh\u00e2n kh\u00f3 ch\u1ecbu khi \u1ed1ng soi qua ch\u1ed7 n\u1ed1i tr\u1ef1c tr\u00e0ng – \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng.<\/p>\n

\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n hay s\u1ee3 s\u1ec7t, tr\u01b0\u1edbc khi soi c\u00f3 th\u1ec3 cho m\u1ed9t \u00edt thu\u1ed1c an th\u1ea7n.<\/p>\n

2. T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n<\/p>\n

Th\u00f4ng th\u01b0\u1eddng ng\u01b0\u1eddi ta d\u00f9ng th\u1ebf ch\u1ed5ng m\u00f4ng. \u0110\u1ea7u g\u1ed1i qu\u00ec v\u00e0 \u00fap l\u00ean m\u1eb7t b\u00e0n. L\u01b0ng \u01b0\u1ee1nv\u00e0 m\u00f4ng nh\u00f4 cao. \u1edf t\u01b0 th\u1ebf n\u00e0y, h\u01b0\u1edbng \u0111i c\u1ee7a tr\u1ef1c tr\u00e0ng tr\u00f9ng v\u1edbi h\u01b0\u1edbng nh\u00ecn c\u1ee7a th\u1ea7ythu\u1ed1c.<\/p>\n

3. Soi h\u1eadu m\u00f4n<\/p>\n

\u1ed0ng soi h\u1eadu m\u00f4n b\u1eb1ng kim lo\u1ea1i, d\u00e0i 6cm, \u0111\u1eeb\u1eddng kinh 2-3cm, \u0111\u1ea7u v\u1eaft, c\u00f3 n\u00f2ng \u0111\u1ea7u t\u00f9.<\/p>\n

\u1ed0ng ph\u1ea3i \u0111\u01b0\u1ee3c b\u00f4i tr\u01a1n tr\u01b0\u1edbc khi \u0111\u1eb7t. Th\u01b0\u1eddng th\u00ec \u0111\u1eb7t r\u1ea5t d\u1ec5 tr\u1eeb khi co th\u1eaft co c\u1ee9ng trongtr\u01b0\u1eddng h\u1ee3p n\u1ee9t h\u1eadu m\u00f4n. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y mu\u1ed1n soi ph\u1ea3i ph\u00f3ng b\u1ebf c\u01a1 th\u1eaft b\u1eb1ngthu\u1ed1c t\u00ea (xylocaine).<\/p>\n

Cho ng\u1eadp h\u1ebft \u1ed1ng soi. Sau \u0111\u00f3 r\u00fat d\u1ea7n ra, v\u1eeba r\u00fat v\u1eeba quay \u1ed1ng soi \u0111\u1ec3 nh\u00ecn \u0111\u01b0\u1ee3c t\u1ea5t c\u1ea3 m\u1ecdim\u1eb7t c\u1ee7a ph\u1ea7n d\u01b0\u1edbi b\u00f3ng tr\u1ef1c tr\u00e0ng v\u00e0 \u1ed1ng h\u1eadu m\u00f4n.<\/p>\n

C\u00e1c th\u01b0\u01a1ng t\u1ed5n \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n:<\/p>\n

– + Ni\u00eam m\u1ea1c ph\u1ed3ng l\u00ean t\u1eebng b\u00fai do c\u00e1c t\u0129nh m\u1ea1ch n\u1eb1m d\u01b0\u1edbi ni\u00eam m\u1ea1c b\u1ecb gi\u00e3n.<\/p>\n

– + C\u00e1c khe, c\u00e1c van \u1edf \u0111\u01b0\u1eddng r\u0103ng c\u01b0a b\u1ecb vi\u00eam.<\/p>\n

– + S\u00f9i lo\u00e9t c\u1ee7a ung th\u01b0 h\u1eadu m\u00f4n, ung th\u01b0 tr\u1ef1c tr\u00e0ng. Trong th\u1ec3 ung th\u01b0 th\u00e2m nhi\u1ec5m th\u0103mb\u1eb1ng tay d\u1ec5 ph\u00e1t hi\u1ec7n h\u01a1n nh\u01b0ng soi cho ph\u00e9p sinh thi\u1ebft.<\/p>\n

– + Th\u01b0\u01a1ng t\u1ed5n vi\u00eam ni\u00eam m\u1ea1c m\u00e0 khi th\u0103m b\u1eb1ng tay kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c.<\/p>\n

Ngo\u00e0i ra qua \u1ed1ng n\u1ed9i soi c\u00f3 th\u1ec3 l\u00e0m c\u00e1c th\u1ee7 thu\u1eadt: Ti\u00eam l\u00e0m x\u01a1 c\u00e1c b\u00fai tr\u0129, th\u1eaft b\u00fai tr\u0129, c\u1eaftv\u00e0 \u0111\u1ed1t \u0111i\u1ec7n polyp.<\/p>\n

4. Soi tr\u1ef1c tr\u00e0ng – \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng<\/p>\n

\u1ed0ng soi tr\u1ef1c tr\u00e0ng c\u00f3 nhi\u1ec1u c\u1ee1, d\u00e0i 15-20-25 hay 30cm, \u0111\u01b0\u1eddng k\u00ednh th\u01b0\u1eddng d\u00f9ng l\u00e0 2cm.<\/p>\n

\u1ed0ng soi c\u00f3 n\u00f2ng, c\u00f3 \u0111\u00e8n v\u00e0 c\u00f3 k\u00ednh.<\/p>\n

\u0110\u1eb7t \u1ed1ng soi c\u00f3 n\u00f2ng sau khi \u0111\u01b0\u1ee3c b\u00f4i tr\u01a1n \u0111\u1ea7y \u0111\u1ee7. Khi v\u00e0o t\u1edbi b\u00f3ng tr\u1ef1c tr\u00e0ng th\u00ec r\u00fatn\u00f2ng, l\u1eafp \u0111\u00e8n v\u00e0 k\u00ednh. V\u1eeba b\u01a1m h\u01a1i v\u1eeba nh\u00ecn r\u00f5 \u0111\u01b0\u1eddng \u0111i v\u1eeba \u0111\u1ea9y \u1ed1ng soi v\u00e0o. Khi \u1ed1ngsoi v\u01b0\u1ee3t qua ch\u1ed7 n\u1ed1i b\u00f3ng tr\u1ef1c tr\u00e0ng – \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng b\u1ec7nh nh\u00e2n th\u1ea5y kh\u00f3 ch\u1ecbu.<\/p>\n

Quan s\u00e1t th\u01b0\u01a1ng t\u1ed5n khi r\u00fat t\u1eeb t\u1eeb \u1ed1ng soi tr\u1edf ra.<\/p>\n

Khi \u0111\u1ea9y \u1ed1ng soi v\u00e0o ph\u1ea3i nh\u00ecn r\u00f5 \u0111\u01b0\u1eddng \u0111i, n\u1ebfu kh\u00f4ng c\u00f3 th\u1ec3 l\u00e0m th\u1ee7ng tr\u1ef1c tr\u00e0ng nh\u1ea5t l\u00e0khi m\u00f4 c\u1ee7a th\u00e0nh tr\u1ef1c tr\u00e0ng kh\u00f4ng t\u1ed1t.<\/p>\n

Soi tr\u1ef1c tr\u00e0ng d\u1ec5 ph\u00e1t hi\u1ec7n nh\u1ee9ng th\u01b0\u01a1ng t\u1ed5n c\u1ee7a b\u00f3ng tr\u1ef1c tr\u00e0ng v\u00e0 c\u1ee7a 1\/3 d\u01b0\u1edbi \u0111\u1ea1itr\u00e0ng ch\u1eadu h\u00f4ng. C\u00e1c th\u01b0\u01a1ng t\u1ed5n \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y.<\/p>\n

– + Ung th\u01b0.<\/p>\n

-+ Polyp \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c nhi\u1ec1u polyp nh\u1ecf (b\u1ec7nh polyp).<\/p>\n

– + Vi\u00eam tr\u1ef1c tr\u00e0ng \u0111\u1ea1i tr\u00e0ng ch\u1ea3y m\u00e1u.<\/p>\n

– + C\u00e1c l\u1ed7 r\u00f2 do v\u1ebft th\u01b0\u01a1ng r\u1ea5t kh\u00f3 th\u1ea5y v\u00ec b\u1ecb c\u00e1c n\u1ebfp ni\u00eam m\u1ea1c l\u1ea5p.<\/p>\n

– + Qua soi c\u00f3 th\u1ec3 sinh thi\u1ebft v\u00e0 l\u00e0m c\u00e1c th\u1ee7 thu\u1eadt kh\u00e1c.<\/p>\n

II. SI\u00caU \u00c2M V\u1edaI \u0110\u1ea6U D\u00d2 TRONG L\u00d2NG TR\u1ef0C TR\u00c0NG<\/p>\n

Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y gi\u00fap ta ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c \u0111\u01b0\u1ee3c v\u1ecb tr\u00ed, k\u00edch th\u01b0\u1edbc c\u1ee7a kh\u1ed1i abces c\u1ea1nhh\u1eadu m\u00f4n, ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c b\u1ec7nh r\u00f2 h\u1eadu m\u00f4n, v\u1ecb tr\u00ed \u0111\u01b0\u1eddng r\u00f2… ngo\u00e0i ra si\u00eau \u00e2m v\u1edbi \u0111\u1ea7u d\u00f2 trong l\u00f2ng tr\u1ef1c tr\u00e0ng c\u00f2n gi\u00fap ta ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c th\u01b0\u01a1ng t\u1ed5n ung th\u01b0 tr\u1ef1c tr\u00e0ng h\u1eadu m\u00f4nv\u00e0 \u0111\u1ed9 x\u00e2m l\u1ea5n c\u1ee7a ung th\u01b0 tr\u00ean th\u00e0nh ru\u1ed9t v\u00e0 c\u00e1c c\u01a1 quan l\u00e2n c\u1eadn v\u00e0 c\u00f2n gi\u00fap ch\u1ea9n \u0111o\u00e1n\u0111\u01b0\u1ee3c ch\u00ednh x\u00e1c c\u00e1c b\u1ec7nh l\u00fd v\u00f9ng quanh h\u1eadu m\u00f4n.<\/p>\n

C\u00e2u 11: Bi\u1ec3u hi\u1ec7n ls v\u00e0 cls c\u1ee7a m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng v\u00e0 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng<\/p>\n

C\u00e2u 47: Tr\u00ecnh b\u00e0y c\u00e1ch kh\u00e1m tri gi\u00e1c v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng trong ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o?<\/p>\n

I. KH\u00c1M TRI GI\u00c1C<\/p>\n

\u0110\u1ec3 tr\u00e1nh t\u00ecnh tr\u1ea1ng tri gi\u00e1c b\u1ec7nh nh\u00e2n t\u1ed1t hay x\u1ea5u d\u1ea7n ta d\u00f9ng b\u1ea3ng GLASGOW nh\u01b0 sau<\/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

II. C\u00c1C TH\u01af\u01a0NG T\u1ed4N TH\u01af\u1edcNG G\u1eb6P<\/p>\n

1. DA \u0110\u1ea6U<\/p>\n

– S\u01b0ng b\u1ea7m da \u0111\u1ea7u, mu\u1ed1n th\u1ea5y \u0111\u01b0\u1ee3c \u0111\u00f4i khi c\u1ea7n ph\u1ea3i c\u1ea1o t\u00f3c b\u1ec7nh nh\u00e2n, c\u00f3 th\u1ec3 n\u1ee9t s\u1ecd ngay ph\u00eda da s\u01b0ng b\u1ea7m.<\/p>\n

– Khi c\u00f3 v\u1ee1 x\u01b0\u01a1ng \u0111\u00e1, v\u00f9ng da sau tai th\u01b0\u1eddng s\u01b0ng b\u1ea7m, \u0111\u00e2y l\u00e0 d\u1ea5u hi\u1ec7u BATTLE.<\/p>\n

– T\u1ee5 m\u00e1u d\u01b0\u1edbi da \u0111\u1ea7u: c\u00f3 hai lo\u1ea1i:<\/p>\n

+ T\u1ee5 m\u00e1u d\u01b0\u1edbi m\u00e0ng x\u01b0\u01a1ng: K\u00edch th\u00edch gi\u1edbi h\u1ea1n b\u1edfi c\u00e1c \u0111\u01b0\u1eddng kh\u1edbp s\u1ecd.<\/p>\n

+ T\u1ee5 m\u00e1u d\u01b0\u1edbi gal\u00e9a: th\u01b0\u1eddng lan r\u1ed9ng d\u01b0\u1edbi da \u0111\u1ea7u.<\/p>\n

– M\u00e1u t\u1ee5 d\u01b0\u1edbi da \u0111\u1ea7u \u1edf c\u1ea3 hai lo\u1ea1i tr\u00ean th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u01a1 th\u1ec3 h\u1ea5p th\u1ee5 r\u1ea5t t\u1ed1t, kh\u00f4ng n\u00ean ch\u1ecdc h\u00fat v\u00ec d\u1ec5 g\u00e2y ra nhi\u1ec5m tr\u00f9ng, d\u1eabn t\u1edbi t\u1ee5 m\u1ee7 d\u01b0\u1edbi da \u0111\u1ea7u, vi\u00eam x\u01b0\u01a1ng s\u1ecd, \u00e1p xe n\u00e3o \u2026<\/p>\n

– R\u00e1ch da \u0111\u1ea7u: L\u00e0 th\u01b0\u01a1ng t\u1ed5n th\u01b0\u1eddng g\u1eb7p trong ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, c\u1ea7n c\u1ea1o r\u1ed9ng t\u00f3c quanh v\u1ebft th\u01b0\u01a1ng \u0111\u1ec3 th\u00e1m s\u00e1t xem c\u00e1c th\u01b0\u01a1ng t\u1ed5n k\u00e8m theo nh\u01b0: b\u1ec3 l\u00fan s\u1ecd, d\u00f2 d\u1ecbch n\u00e3o, l\u1ed3i m\u00f4 n\u00e3o qua ch\u1ed7 r\u00e1ch da.<\/p>\n

2. N\u1ee8T S\u1ecc \u0110\u01af\u1edcNG TH\u1eb2NG: N\u00ean \u0111\u1ec3 \u00fd xem \u0111\u01b0\u1eddng n\u1ee9t s\u1ecd c\u00f3 \u0111i ngang.<\/p>\n

– C\u00e1c m\u1ea1ch m\u00e1u l\u1edbn d\u1ec5 g\u00e2y ra m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng nh\u01b0:<\/p>\n

+ V\u00f9ng th\u00e1i d\u01b0\u01a1ng: \u0111\u01b0\u1eddng n\u1ee9t s\u1ecd c\u00f3 th\u1ec3 g\u00e2y ra \u0111\u1ee9t \u0111\u1ed9ng m\u1ea1ch m\u00e0ng n\u00e3o gi\u1eefa.<\/p>\n

+ V\u00f9ng \u0111\u1ec9nh gi\u1eefa hay ch\u1ea9m c\u00f3 th\u1ec3 l\u00e0m r\u00e1ch xoang t\u0129nh m\u1ea1ch.<\/p>\n

– Xoang tr\u00e1n: C\u00f3 th\u1ec3 g\u00e2y nhi\u1ec5m tr\u00f9ng s\u1ecd n\u00e3o, d\u00f9 l\u00e0 ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o k\u00edn.<\/p>\n

a. N\u1ee9t s\u1ecd \u0111\u01b0\u1eddng th\u1eb3ng c\u00f3 h\u1edf: Khi \u0111\u01b0\u1eddng n\u1ee9t r\u1ed9ng qu\u00e1 3mm, x\u1ea3y ra nhi\u1ec1u \u1edf tu\u1ed5i nh\u0169 nhi, c\u00f3 th\u1ec3 l\u00e0m r\u00e1ch m\u00e0ng c\u1ee9ng g\u00e2y ra v\u1ee1 s\u1ecd ti\u1ebfn tri\u1ec3n.<\/p>\n

b. V\u1ee1 s\u1ecd ti\u1ebfn tri\u1ec3n: X\u1ea3y ra nhi\u1ec1u \u1edf tu\u1ed5i nh\u0169 nhi, l\u00e0m m\u00f4 n\u00e3o tho\u00e1t v\u1ecb qua khe n\u1ee9t s\u1ecd, g\u00e2y ra di ch\u1ee9ng teo n\u00e3o, r\u1ed7ng n\u00e3o. Kh\u00e1m l\u00e2m s\u00e0ng th\u01b0\u1eddng th\u1ea5y m\u1ed9t kh\u1ed1i u d\u01b0\u1edbi da \u0111\u1ea7u, \u0111\u1eb7c bi\u1ec7t theo nh\u1ecbp \u0111\u1eadp c\u1ee7a n\u00e3o. Kh\u00f4ng n\u00ean d\u00f9ng kim ch\u1ecdc h\u00fat v\u00ec d\u1ec5 g\u00e2y nhi\u1ec5m tr\u00f9ng.<\/p>\n

V\u1ee1 s\u1ecd ti\u1ebfn tri\u1ec3n l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u1ea7n c\u1ea5p c\u1ee9u \u0111\u1ec3 tr\u00e1nh c\u00e1c d\u01b0 ch\u1ee9ng v\u1eeba k\u1ec3 v\u00e0 \u0111\u1ec3 tr\u00e1nh s\u1ef1 x\u00e9 r\u1ed9ng m\u00e0ng c\u1ee9ng do x\u01b0\u01a1ng ti\u1ebfp t\u1ee5c b\u1ecb to\u00e1c r\u1ed9ng.<\/p>\n

c. V\u1ee1 x\u01b0\u01a1ng tr\u00e1n cung m\u1eaft, tr\u1ea7n h\u1ed1c m\u1eaft: m\u00e1u s\u1ebd ch\u1ea3y ng\u1ea5m v\u00e0o m\u00f4 m\u1ee1 \u1edf h\u1ed1c m\u1eaft, g\u00e2y ra s\u1ef1 b\u1ea7m hai mi m\u1eaft: d\u1ea5u hi\u1ec7u k\u00ednh r\u00e2m.<\/p>\n

d. V\u1ee1 s\u00e0n s\u1ecd: C\u00f3 th\u1ec3 l\u00e0m d\u00f2 d\u1ecbch n\u00e3o t\u1ee7y \u1edf:<\/p>\n

+ M\u0169i: Ch\u1ee5p X_ Quang c\u00f3 th\u1ec3 th\u1ea5y h\u01a1i trong h\u1ed9p s\u1ecd.<\/p>\n

+ Tai: Kh\u00e1m th\u1ea5y c\u00f3 d\u1ea5u Battle \u1edf v\u00f9ng x\u01b0\u01a1ng ch\u0169m v\u00e0 m\u00e0ng nh\u0129 b\u1ecb r\u00e1ch.<\/p>\n

3. M\u00c1U T\u1ee4 TRONG S\u1ecc<\/p>\n

a. M\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng:<\/p>\n

\u00b7 Hi\u1ebfm g\u1eb7p \u1edf tu\u1ed5i nh\u0169 nhi.<\/p>\n

\u00b7 Ngu\u1ed3n ch\u1ea3y m\u00e1u: \u0110\u1ed9ng m\u1ea1ch m\u00e0ng n\u00e3o, xoang t\u0129nh m\u1ea1ch d\u1ecdc tr\u00ean, xoang t\u0129nh m\u1ea1ch ngang ho\u1eb7c t\u1eeb x\u01b0\u01a1ng n\u1ee9t.<\/p>\n

\u00b7 BN th\u01b0\u1eddng c\u00f3 kho\u1ea3ng t\u1ec9nh t\u1eeb v\u00e0i gi\u1edd \u0111\u1ebfn 24 gi\u1edd, c\u00f3 v\u00e0i tr\u01b0\u1eddng h\u1ee3p kho\u1ea3ng t\u1ec9nh k\u00e9o d\u00e0i l\u00e2u h\u01a1n.<\/p>\n

\u00b7 Tri\u1ec7u ch\u1ee9ng: b\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 d\u1ea5u hi\u1ec7u nh\u1ee9c \u0111\u1ea7u, \u00f3i, \u0111\u1ed9ng kinh, d\u1ea5u hi\u1ec7u th\u1ea7n kinh khu tr\u00fa. \u1ede tr\u1ebb em d\u1ea5u hi\u1ec7u m\u1ea5t m\u00e1u th\u01b0\u1eddng c\u00f3.<\/p>\n

\u00b7 X_Quang s\u1ecd: 75% tr\u01b0\u1eddng h\u1ee3p c\u00f3 n\u1ee9t s\u1ecd.<\/p>\n

\u00b7 Ch\u1ea9n \u0111o\u00e1n c\u01a1 b\u1ea3n nh\u1ea5t l\u00e0 CT Scan \u0111\u1ea7u.<\/p>\n

T\u1ec9 l\u1ec7 m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng s\u1ecd v\u1edbi ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o kh\u00f4ng cao nh\u01b0ng c\u1ea7n bi\u1ebft ph\u00e1t hi\u1ec7n c\u00e1c m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng trong h\u1ed9p s\u1ecd v\u00ec m\u1ed5 c\u00f3 th\u1ec3 c\u1ee9u s\u1ed1ng b\u1ec7nh nh\u00e2n v\u00e0 \u00edt \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng.<\/p>\n

b. M\u00e1u t\u1ee5 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng:C\u00f3 hai lo\u1ea1i c\u1ea5p di\u1ec5n v\u00e0 b\u00e1n c\u1ea5p:<\/p>\n

v M\u00e1u t\u1ee5 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng c\u1ea5p<\/p>\n

\u00b7 Tr\u1ebb s\u01a1 sinh: Th\u01b0\u1eddng do tai bi\u1ebfn l\u00fac sinh, b\u00e9 c\u00f3 tri\u1ec7u ch\u1ee9ng th\u1edf kh\u00f3, gi\u00e3n \u0111\u1ed3ng t\u1eed, th\u00f3p tr\u01b0\u1edbc ph\u1ed3ng, xuy\u1ebft huy\u1ebft v\u00f5ng m\u1ea1c. Ngu\u1ed3n g\u1ed1c ch\u1ea3y m\u00e1u: R\u00e1ch \u0111\u1ed9ng m\u1ea1ch v\u1ecf n\u00e3o.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n: Ch\u1ecdc th\u00f3p tr\u01b0\u1edbc th\u1ea5y d\u1ecbch n\u00e3o t\u1ee7y m\u00e0u h\u1ed3ng ch\u1ea3y ra, kh\u00f4ng \u0111\u00f4ng.<\/p>\n

\u00b7 Ng\u01b0\u1eddi l\u1edbn: Ngu\u1ed3n ch\u1ea3y m\u00e1u: Do r\u00e1ch t\u0129nh m\u1ea1ch n\u1ed1i v\u1ecf n\u00e3o v\u00e0 xoang t\u0129nh m\u1ea1ch<\/p>\n

Tri\u1ec7u ch\u1ee9ng: tri gi\u00e1c gi\u1ea3m, d\u1ea5u th\u1ea7n kinh khu tr\u00fa. Ch\u1ea9n \u0111o\u00e1n: L\u00e0m CT Scan n\u00e3o th\u1ea5y l\u1edbp m\u00e1u t\u1ee5 lan t\u1ecfa, n\u1ebfu b\u1ec1 d\u00e0y m\u00e1u t\u1ee5 d\u01b0\u1edbi 5mm th\u01b0\u1eddng tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u00edt c\u00f3. D\u1ef1 h\u1eadu: x\u1ea5u do k\u00e8m d\u1eadp n\u00e3o.<\/p>\n

v M\u00e1u t\u1ee5 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng b\u00e1n c\u1ea5p: Th\u01b0\u1eddng x\u1ea3y ra sau 7 \u2013 10 ng\u00e0y sau khi ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, (th\u1eddi gian n\u00e0y t\u00f9y quan ni\u1ec7m m\u1ed7i t\u00e1c gi\u1ea3), khi m\u1ed5 th\u1ea5y \u1ed5 m\u00e1u t\u1ee5 \u0111\u01b0\u1ee3c bao b\u1eb1ng m\u1ed9t m\u00e0ng gi\u1ea3 fibrin.<\/p>\n

\u00b7 B\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m:<\/p>\n

H\u1ecfi ti\u1ec1n c\u0103n b\u1ea3n ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o.<\/p>\n

Kh\u00e1m c\u00f3: D\u1ea5u hi\u1ec7u t\u0103ng \u00e1p l\u1ef1c trong s\u1ecd, \u0111\u1eb7c bi\u1ec7t d\u1ea5u ph\u00f9 gai th\u1ecb sau ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o; d\u1ea5u hi\u1ec7u th\u1ea7n kinh khu tr\u00fa t\u00f9y v\u1ecb tr\u00ed m\u00e1u t\u1ee5 ch\u00e8n \u00e9p.<\/p>\n

\u00b7 C\u1eadn l\u00e2m s\u00e0ng:<\/p>\n

X_ Quang s\u1ecd th\u01b0\u1eddng: c\u00f3 h\u00f3a v\u00f4i \u1ed5 m\u00e1u t\u1ee5 m\u00e3n t\u00ednh (hi\u1ebfm g\u1eb7p).<\/p>\n

M\u1ea1ch n\u00e3o \u0111\u1ed3: Kho\u1ea3ng v\u00f4 m\u1ea1ch h\u00ecnh th\u1ea5u k\u00ednh.<\/p>\n

C.T n\u00e3o: ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c nh\u1ea5t v\u1edbi h\u00ecnh \u1ea3nh th\u1ea5u k\u00ednh.<\/p>\n

c. M\u00e1u t\u1ee5 trong n\u00e3o<\/p>\n

Do \u0111\u1ee9t m\u1ea1ch m\u00e1u d\u01b0\u1edbi v\u1ecf n\u00e3o<\/p>\n

X\u1ea3y ra nhi\u1ec1u \u1edf th\u00f9y tr\u00e1n v\u00e0 th\u00f9y th\u00e1i d\u01b0\u01a1ng do c\u01a1 ch\u1ebf ch\u1ea5n \u0111\u1ed9ng d\u1ed9i (contre coup).<\/p>\n

L\u00e2m s\u00e0ng: nh\u01b0 m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng v\u00e0 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n: CT Scan n\u00e3o<\/p>\n

M\u1ed5 khi tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ti\u1ebfn tri\u1ec3n x\u1ea5u.<\/p>\n

d. T\u1ee5 d\u1ecbch n\u00e3o t\u1ee7y<\/p>\n

Do r\u00e1ch m\u00e0ng nh\u1ec7n: Van m\u1ed9t chi\u1ec1u, d\u1ecbch n\u00e3o t\u1ee7y tho\u00e1t ra ngo\u00e0i m\u00e0ng nh\u1ec7n \u0111\u1ecdng l\u1ea1i gi\u1eefa m\u00e0ng nh\u1ec7n v\u00e0 m\u00e0ng c\u1ee9ng m\u00e0 kh\u00f4ng ch\u1ea3y tr\u1edf l\u1ea1i h\u1ec7 th\u1ed1ng d\u1ecbch n\u00e3o t\u1ee7y.<\/p>\n

Th\u01b0\u1ee1ng x\u1ea3y ra nhi\u1ec1u ng\u00e0y ho\u1eb7c nhi\u1ec1u tu\u1ea7n sau ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o.<\/p>\n

Tri\u1ec7u ch\u1ee9ng nh\u01b0 m\u00e1u t\u1ee5 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng.<\/p>\n

4. TH\u01af\u01a0NG T\u1ed4N N\u00c3O<\/p>\n

a. Ch\u1ea5n \u0111\u1ed9ng n\u00e3o (Concussion)<\/p>\n

R\u1ed1i lo\u1ea1n t\u1ea1m th\u1eddi c\u00e1c ch\u1ee9c n\u0103ng c\u00e1c m\u00f4 th\u1ea7n kinh.<\/p>\n

L\u00e2m s\u00e0ng: R\u1ed1i lo\u1ea1n tri gi\u00e1c ng\u1eafn, t\u1ec9nh d\u1eady b\u1ec7nh nh\u00e2n qu\u00ean c\u00e1c s\u1ef1 vi\u1ec7c \u0111\u00e3 x\u1ea3y ra.<\/p>\n

\u1ede tr\u1ebb nh\u1ecf: cho\u00e1ng v\u00e1ng, \u00f3i, xanh xao. Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng ng\u01b0\u1eddi m\u1ec1m nh\u0169n, \u0111\u1ed3ng t\u1eed gi\u00e3n h\u1ebft ph\u1ea3n x\u1ea1, ng\u01b0ng th\u1edf t\u1ea1m th\u1eddi.<\/p>\n

b. D\u1eadp n\u00e3o<\/p>\n

80% \u2013 90% ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o n\u1eb7ng c\u00f3 d\u1eadp n\u00e3o k\u00e8m xu\u1ea5t huy\u1ebft ho\u1ea1i t\u1eed, r\u00e1ch m\u00f4 n\u00e3o, ph\u00f9 n\u00e3o th\u01b0\u1eddng x\u1ea3y ra \u1edf th\u00f9y tr\u00e1n, th\u00f9y th\u00e1i d\u01b0\u01a1ng do c\u01a1 ch\u1ebf ch\u1ea5n \u0111\u1ed9ng d\u1ed9i.<\/p>\n

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

C\u1ea7n theo d\u00f5i \u0111\u1ed9 h\u00f4n m\u00ea.<\/p>\n

H\u1ed9i ch\u1ee9ng th\u00f9y th\u00e1i d\u01b0\u01a1ng: tri gi\u00e1c, li\u1ec7t n\u1eeda ng\u01b0\u1eddi, gi\u00e3n \u0111\u1ed3ng t\u1eed.<\/p>\n

R\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p.<\/p>\n

Ph\u00f9 ph\u1ed5i.<\/p>\n

Nhi\u1ec7t \u0111\u1ed9 t\u0103ng.<\/p>\n

Lo\u00e9t d\u1ea1 d\u00e0y: \u1ede tr\u01b0\u1eddng h\u1ee3p d\u1eadp n\u00e3o k\u00e8m ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/p>\n

C\u00e2u 48: Tr\u00ecnh b\u00e0y c\u01a1 ch\u1ebf kh\u00e1m ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o?<\/p>\n

Kh\u00e1m ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o c\u1ea7n theo d\u00f5i th\u01b0\u1eddng xuy\u00ean v\u00e0 \u0111\u1ec1u \u0111\u1eb7n \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c th\u01b0\u01a1ng t\u1ed5n xu\u1ea5t hi\u1ec7n \u0111\u1eb7c bi\u1ec7t l\u00e0 d\u1ea5u hi\u1ec7u tri gi\u00e1c v\u00e0 d\u1ea5u th\u1ea7n kinh khu tr\u00fa.<\/p>\n

I. KH\u00c1M T\u00ccNH TR\u1ea0NG CHUNGH\u1ecfi<\/p>\n

1. C\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng<\/p>\n

Nguy\u00ean nh\u00e2n g\u00e2y ra tai n\u1ea1n<\/p>\n

Ho\u00e0n c\u1ea3nh n\u01a1i x\u1ea3y ra tai n\u1ea1n<\/p>\n

2. T\u00ecnh h\u00ecnh v\u00e0 di\u1ec5n ti\u1ebfnc\u1ee7a b\u1ec7nh nh\u00e2n t\u1eeb k\u00fac b\u1ecb ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o \u0111\u1ebfn l\u00fac \u0111\u01b0\u1ee3c kh\u00e1m.<\/p>\n

B\u00ean c\u1ea1nh c\u00f3 kho\u1ea3ng t\u1ec9nh hay kh\u00f4ng?<\/p>\n

C\u00f3 k\u00e8m c\u00e1c th\u01b0\u01a1ng t\u1ed5n \u1edf c\u00e1c c\u01a1 quan kh\u00e1c?<\/p>\n

II. L\u00c2M S\u00c0NG V\u00c0 T\u1ed4NG QU\u00c1T<\/p>\n

1. Quan s\u00e1t h\u1ed9p s\u1ecd<\/p>\n

* D\u1ea5u hi\u1ec7u v\u1ee1 s\u00e0n s\u1ecd:<\/p>\n

D\u1ea5u hi\u1ec7u k\u00ednh r\u00e2m (m\u1eaft g\u1ea5u tr\u00fac).<\/p>\n

D\u1ea5u hi\u1ec7u b\u1ea7m m\u00e1u sau tai: Battle.<\/p>\n

Ch\u1ea3y d\u1ecbch n\u00e3o t\u1ee7y tai \u2013 m\u0169i<\/p>\n

T\u1ee5 m\u00e1u m\u00e0ng nh\u0129, r\u00e1ch \u1ed1ng tai ngo\u00e0i.<\/p>\n

2. V\u1ee1 x\u01b0\u01a1ng m\u1eb7t<\/p>\n

G\u00e3y Lefort: T\u00ecm \u0111i\u1ec3m \u0111au x\u01b0\u01a1ng m\u1eb7t, cung g\u00f2 m\u00e1.<\/p>\n

G\u00e3y b\u1edd h\u1ed1c m\u1eaft.<\/p>\n

3. Ph\u00f9 n\u1ec1 quanh h\u1ed1c m\u1eaft, l\u1ed3i m\u1eaft<\/p>\n

4. Nghe<\/p>\n

M\u1ea1ch ch\u1eadm d\u1ea7n<\/p>\n

Huy\u1ebft \u00e1p t\u0103ng d\u1ea7n<\/p>\n

Nhi\u1ec7t \u0111\u1ed9 t\u0103ng d\u1ea7n<\/p>\n

Nh\u1ecbp th\u1edf: nhanh ho\u1eb7c r\u1ed1i lo\u1ea1n, \u1edf giai \u0111o\u1ea1n n\u1eb7ng nh\u1ecbp th\u1edf ch\u1eadm (Theo Cushing).<\/p>\n

III. D\u1ea4U HI\u1ec6U TH\u1ea6N KINH<\/p>\n

1. D\u1ea5u hi\u1ec7u m\u00e0ng n\u00e3o<\/p>\n

C\u00f3 \u1edf b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam m\u00e0ng n\u00e3o v\u00ec c\u00f3 v\u1ebft th\u01b0\u01a1ng s\u1ecd n\u00e3o \u0111\u1ebfn tr\u1ec5 ho\u1eb7c \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb kh\u00f4ng t\u1ed1t.<\/p>\n

B\u1ec7nh nh\u00e2n b\u1ecb xu\u1ea5t huy\u1ebft d\u01b0\u1edbi m\u00e0ng nh\u1ec7n th\u01b0\u1eddng c\u00f3 d\u1ea5u m\u00e0ng n\u00e3o. C\u1ea7n cho b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n xem c\u00f3 v\u1ee1 d\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u n\u00e3o.<\/p>\n

2. Th\u1ea7n kinh th\u1ecb gi\u00e1c<\/p>\n

B\u1ec7nh nh\u00e2n t\u1ec9nh:Xem b\u1ec7nh c\u00f3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u1ecdc ch\u1eef in, \u0111\u1ebfm ng\u00f3n tay, th\u1ea5y c\u1eed \u0111\u1ed9ng tay, nh\u1eadn bi\u1ebft \u00e1nh s\u00e1ng.<\/p>\n

Tr\u1ebb em c\u00f3 th\u1ec3 m\u00f9 v\u1ecf n\u00e3o 1 – 2 ng\u00e0y sau ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o v\u00f9ng ch\u1ea9m.<\/p>\n

B\u1ec7nh nh\u00e2n m\u00ea: Xem \u0111\u1ed3ng t\u1eed ph\u1ea3n x\u1ea1 v\u1edbi \u00e1nh s\u00e1ng.<\/p>\n

\u0110\u1ed3ng t\u1eed:D\u1ea5u d\u00e3n \u0111\u1ed3ng t\u1eed: l\u00e0 d\u1ea5u hi\u1ec7u quan tr\u1ecdng: \u0110\u1ed3ng t\u1eed d\u00e3n d\u1ea7n do m\u00e1u t\u1ee5 l\u1edbn d\u00e0n g\u00e2y t\u1ee5t n\u00e3o h\u1ed3i h\u1ea3i m\u00e3 th\u00f9y th\u00e1i d\u01b0\u01a1ng, \u0111\u1ed3ng t\u1eed th\u01b0\u1eddng gi\u00e3n v\u00e0 m\u1ea5t ph\u1ea3n x\u1ea1 \u00e1nh s\u00e1ng c\u00f9ng b\u00ean v\u1edbi kh\u1ed1i m\u00e1u t\u1ee5. Tuy nhi\u00ean n\u1ebfu \u0111\u1ed3ng t\u1eed gi\u00e3n ngay sau khi ch\u1ea5n th\u01b0\u01a1ng th\u00ec ph\u1ea3i xem c\u00f3 ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp v\u00e0o m\u1eaft l\u00e0m d\u00e2y III t\u1ed5n th\u01b0\u01a1ng g\u00e2y gi\u00e3n \u0111\u1ed3ng t\u1eed hay kh\u00f4ng? Tr\u01b0\u1eddng h\u1ee3p n\u00e0y kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n m\u00e1u t\u1ee5 trong s\u1ecd.<\/p>\n

3. D\u00e2y VII: Xem c\u00f3 d\u1ea5u hi\u1ec7u li\u1ec7t th\u1ea7n kinh VII ngo\u1ea1i bi\u00ean.<\/p>\n

4. \u0110\u00e1y m\u1eaft: Ph\u00f9, xu\u1ea5t huy\u1ebft tr\u01b0\u1edbc v\u00f5ng m\u1ea1c, b\u00f3c t\u00e1ch v\u00f5ng m\u1ea1c, t\u1ed5n th\u01b0\u01a1ng v\u00f5ng m\u1ea1c.<\/p>\n

IV. KH\u00c1M TRI GI\u00c1C<\/p>\n

\u0110\u1ec3 tr\u00e1nh t\u00ecnh tr\u1ea1ng tri gi\u00e1c b\u1ec7nh nh\u00e2n t\u1ed1t hay x\u1ea5u d\u1ea7n ta d\u00f9ng b\u1ea3ng GLASGOW nh\u01b0 sau:(c\u00e2u 47)<\/p>\n

Thang \u0111i\u1ec3m Glasgow c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 theo nh\u1eefng kho\u1ea3ng c\u00e1ch th\u1eddi gian \u0111\u1ec3 xem tri gi\u00e1c b\u1ec7nh nh\u00e2n t\u1ed1t d\u1ea7n hay x\u1ea5u d\u1ea7n.M\u1ed7i l\u1ea7n \u0111\u00e1nh gi\u00e1 c\u1ea7n ghi t\u1ed5ng s\u1ed1 \u0111i\u1ec3m v\u00e0 m\u1ed7i y\u1ebfu t\u1ed1 l\u00e0 bao nhi\u00eau \u0111\u1ec3 d\u1ec5 theo d\u00f5i s\u1ef1 chuy\u1ec3n bi\u1ebfn c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

V. KH\u00c1M V\u1eacN D\u1ed8NG<\/p>\n

B\u1ec7nh nh\u00e2n h\u1ee3p t\u00e1c: Xem s\u1ee9c c\u01a1 \u2013 tr\u01b0\u1eddng l\u1ef1c co 4 chi.<\/p>\n

B\u1ec7nh nh\u00e2n kh\u00f4ng h\u1ee3p t\u00e1c: Xem \u0111\u00e1p \u1ee9ng c\u1ee7a 4 chi v\u1edbi k\u00edch th\u00edch \u0111au (c\u1ea7n ph\u00e2n bi\u1ec7t ph\u1ea3n x\u1ea1 t\u1ef1 \u0111\u1ed9ng t\u1ee7y).<\/p>\n

N\u1ebfu nghi ng\u1edd t\u1ed5n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng c\u1ea7n kh\u00e1m s\u1ee9c co c\u1ee7a c\u01a1 v\u00f2ng h\u1eadu m\u00f4n, ph\u1ea3n x\u1ea1 h\u00e0nh hang, n\u1ebfp nh\u0103n h\u1eadu m\u00f4n.<\/p>\n

Y\u1ebfu li\u1ec7t n\u1eeda ng\u01b0\u1eddi: Khi b\u1ec7nh nh\u00e2n gi\u00e3y d\u1ee5a ho\u1eb7c kh\u00e1ng c\u1ef1 v\u1edbi k\u00edch th\u00edch \u0111au, tay ch\u00e2n b\u00ean y\u1ebfu li\u1ec7t s\u1ebd c\u1eed \u0111\u1ed9ng \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 so v\u1edbi b\u00ean \u0111\u1ed1i di\u1ec7n.<\/p>\n

VI. KH\u00c1M C\u1ea2M GI\u00c1C<\/p>\n

B\u1ec7nh nh\u00e2n ph\u1ed1i h\u1ee3p: Xem \u0111\u00e1p \u1ee9ng c\u1ee7a c\u1ea3m gi\u00e1c kim ch\u00e2m \u1edf c\u00e1c khoanh c\u1ea3m gi\u00e1c (C4 \u2013 x\u01b0\u01a1ng c\u00f9ng).<\/p>\n

B\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ed1i h\u1ee3p:<\/p>\n

Xem d\u1ea5u hi\u1ec7u li\u1ec7t m\u1eb7t Pierre Marie v\u00e0 Foix.<\/p>\n

VII. KH\u00c1M PH\u1ea2N X\u1ea0<\/p>\n

G\u00e2n x\u01b0\u01a1ng, da b\u1ee5ng, da b\u00ecu<\/p>\n

Babinski.<\/p>\n

C\u00e1c ph\u1ea3n x\u1ea1 h\u1eadu m\u00f4n n\u1ebfu c\u00f3 nghi ng\u1edd t\u1ed5n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng.<\/p>\n

VIII. D\u1ea4U HI\u1ec6U TI\u1ec2U N\u00c3O<\/p>\n

D\u1ea5u hi\u1ec7u rung gi\u1eadt nh\u00e3n c\u1ea7u th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em b\u1ecb m\u00e1u t\u1ee5 h\u1ed1 sau<\/p>\n

C\u00e2u 20: C\u00e1c th\u01b0\u01a1ng t\u1ed5n th\u1ee9 ph\u00e1t g\u00e2y t\u1ed5n th\u01b0\u01a1ng n\u00e3o theo c\u01a1 ch\u1ebf sau:<\/p>\n[\u200bIMG][\u200bIMG] H\u1ea1 huy\u1ebft \u00e1p Thi\u1ebfu oxy<\/p>\n[\u200bIMG][\u200bIMG]Gi\u1ea3m l\u01b0\u1ee3ng t\u01b0\u1edbi m\u00e1u n\u00e3o Thay \u0111\u1ed5i bi\u1ebfn d\u01b0\u1ee1ng<\/p>\n[\u200bIMG][\u200bIMG]\n

T\u1ed5n th\u01b0\u01a1ng c\u00e1c vi m\u1ea1ch M\u00e0ng t\u1ebf b\u00e0o b\u1ecb ph\u00e1 v\u1ee1<\/p>\n[\u200bIMG][\u200bIMG]\n

T\u1ebf b\u00e0o n\u00e3o: ho\u1ea1i t\u1eed ch\u1ebft T\u1ebf b\u00e0o n\u00e3o: thi\u1ebfu oxy-ch\u1ebft<\/p>\n[\u200bIMG][\u200bIMG]\n

T\u0103ng: t\u1eed vong v\u00e0 di ch\u1ee9ng<\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u1edf b\u1ec7nh nh\u00e2n CTSN:<\/p>\n

\u00b7 GCS <15 \u0111i\u1ec3m k\u00e9o d\u00e0i h\u01a1n 2 gi\u1edd sau CTSN.<\/p>\n

\u00b7 Qu\u00ean k\u00e9o d\u00e0i c\u00e1c vi\u1ec7c x\u1ea3y ra sau CTSN.<\/p>\n

\u00b7 Qu\u00ean h\u01a1n 30 ph\u00fat c\u00e1c vi\u1ec7c x\u1ea3y ra tr\u01b0\u1edbc khi CTSN.<\/p>\n

\u00b7 C\u00f3 d\u1ea5u hi\u1ec7n: n\u1ee9t \u2013 l\u00fan s\u1ecd, n\u1ee9t s\u00e0n s\u1ecd.<\/p>\n

\u00b7 Nh\u1ee9c \u0111\u1ea7u d\u1eef d\u1ed9i.<\/p>\n

\u00b7 Tu\u1ed5i:< 2 tu\u1ed5i; > 60 tu\u1ed5i;<\/p>\n

D\u1ea4U HI\u1ec6U L\u00c2M S\u00c0NG<\/p>\n

C\u1ea6N CH\u00da \u00dd<\/p>\n

C\u00c1C Y\u1ebeU T\u1ed0<\/p>\n

C\u1ea6NKI\u1ec2M TRA<\/p>\n

C\u00c1C B\u01af\u1edaC \u0110I\u1ec0U TR\u1eca<\/p>\n

– Thi\u1ebfu oxy<\/p>\n

– Th\u00f4ng kh\u00ed k\u00e9m<\/p>\n

– Kh\u00ed m\u00e1u<\/p>\n

– Nh\u1ecbp th\u1edf<\/p>\n

– \u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n cho b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng CO2, h\u1ea1 O2<\/p>\n

– H\u1ea1 huy\u1ebft \u00e1p<\/p>\n

– Cao huy\u1ebft \u00e1p<\/p>\n

– \u0110o huy\u1ebft \u00e1p<\/p>\n

– Hgb, Hct<\/p>\n

Truy\u1ec1n m\u00e1u khi c\u00f3 \u0111\u1ea5u hi\u1ec7u m\u1ea5t m\u00e1u.<\/p>\n

– \u0110\u1ed9ng kinh<\/p>\n

– \u0110o c\u00e1c \u0111i\u1ec7n gi\u1ea3i<\/p>\n

– \u0110i\u1ec1u ch\u1ec9nh natri, \u0111\u01b0\u1eddng, \u2026<\/p>\n

– Cho c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh.<\/p>\n

– Nhi\u1ec5m tr\u00f9ng<\/p>\n

– S\u1ed1t<\/p>\n

– C\u00f4ng th\u1ee9c b\u1ea1ch c\u1ea7u<\/p>\n

– Nhi\u1ec7t \u0111\u1ed9<\/p>\n

– Ch\u1ecdc d\u00f2 d\u1ecbch n\u00e3o t\u1ee7y n\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7u vi\u00eam m\u00e0ng n\u00e3o, v\u00e0 kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

– S\u1ef1 v\u1eefng ch\u1eafc c\u1ed9t s\u1ed1ng<\/p>\n

-Ch\u1ee5p X_Quang<\/p>\n

– N\u1ebfu c\u1ea7n: C\u1ed1 \u0111\u1ecbnh c\u1ed9t s\u1ed1ng (v\u00f2ng c\u1ed1 \u0111\u1ecbnh c\u1ed9t s\u1ed1ng c\u1ed5, v\u00e1n c\u1ed1 \u0111\u1ecbnh c\u1ed9t s\u1ed1ng ng\u1ef1c l\u01b0ng \u2026)<\/p>\n

\u00b7 R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.<\/p>\n

\u00b7 C\u00f3 c\u01a1 ch\u1ebf b\u1ecb CTSN m\u1ea1nh.<\/p>\n

\u00b7 C\u00f3 d\u1ea5u hi\u1ec7u ng\u1ed9 \u0111\u1ed9c r\u01b0\u1ee3u – \u0111\u1ed9c ch\u1ea5t.<\/p>\n

\u0110\u1ec3 tr\u00e1nh c\u00e1c h\u1eadu qu\u1ea3 khi v\u1eadn chuy\u1ec3n b\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o c\u1ea7n \u0111\u00e1nh gi\u00e1 v\u00e0 \u0111i\u1ec1u ch\u1ec9nh c\u00e1c y\u1ebfu t\u1ed1 theo b\u1ea3ng 1-1.<\/p>\n

B\u1ea3ng 1-1: C\u00e1c y\u1ebfu t\u1ed1 c\u1ea7n quan t\u00e2m khidi chuy\u1ec3n b\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/p>\n

C\u00e2u 50: Ph\u00e2n bi\u1ec7t gi\u1eefa li\u1ec7t ho\u00e0n to\u00e0n v\u00e0 li\u1ec7t kh\u00f4ng ho\u00e0n to\u00e0n?<\/p>\n

Ph\u1ea3i sau 1-3 tu\u1ea7n m\u1edbi ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c.<\/p>\n

LI\u1ec6T HO\u00c0N TO\u00c0N<\/p>\n

Ph\u1ea3n x\u1ea1 co g\u1ea5p chi d\u01b0\u1edbi r\u00f5.<\/p>\n

C\u01b0\u01a1ng d\u01b0\u01a1ng v\u1eadt th\u01b0\u1eddng xuy\u00ean.<\/p>\n

M\u1ea5t ho\u00e0n to\u00e0n c\u00e1c d\u1ea5u hi\u1ec7u th\u1ea7n kinh v\u00e0 kh\u00f4ng ph\u1ee5c h\u1ed3i.<\/p>\n

LI\u1ec6T KH\u00d4NG HO\u00c0N TO\u00c0N<\/p>\n

Ph\u1ea3n x\u1ea1 co g\u1ea5p chi d\u01b0\u1edbi nh\u1eb9 v\u00e0 ch\u1eadm.<\/p>\n

-Kh\u00f4ng m\u1ea5t ho\u00e0n to\u00e0n c\u00e1c d\u1ea5u hi\u1ec7u th\u1ea7n kinh v\u00e0 h\u1ed3i ph\u1ee5c d\u1ea7n<\/p>\n

C\u00e2u 12:C\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng c\u1ed9t s\u1ed1ng<\/p>\n

\u0110\u1ed1i v\u1edbi c\u1ed9t s\u1ed1ng c\u1ed5<\/p>\n

Bao g\u1ed3m 4 c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng : g\u1eadp, l\u00fan, xoay,ng\u1eeda.T\u00e1c \u0111\u1ed9ng l\u00ean c\u1ed9t s\u1ed1ng c\u1ed5 ho\u1eb7c ri\u00eang l\u1ebb ho\u1eb7c ph\u1ed1i h\u1ee3p t\u1ea1o ra c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111a d\u1ea1ng tr\u00ean c\u1ed9t s\u1ed1ng c\u1ed5.<\/p>\n

\u00b7 V\u00f9ng \u0111\u1ea7u C1:g\u00e3y \u0111\u1ed1t s\u1ed1ng C1 c\u01a1 ch\u1ebf ch\u1ee7 y\u1ebfu l\u00e0 l\u00fan<\/p>\n

\u00b7 V\u00f9ng C1-C2 c\u01a1 ch\u1ebf xoay c\u00f3 th\u1ec3 g\u00e2y tr\u1eadt xoay hay b\u00e1n tr\u1eadt C1-C2.<\/p>\n

– G\u00e3y m\u1ea5u r\u0103ng \u0111\u1ed1t s\u1ed1ng C2:c\u00f3 th\u1ec3 do c\u01a1 ch\u1ebf g\u1ea5p ho\u1eb7c ng\u1eeda (\u0111a s\u1ed1 l\u00e0 do c\u01a1 ch\u1ebf g\u1ea5p )<\/p>\n

– G\u00e3y ch\u00e2n cung \u0111\u1ed1t s\u1ed1ng C2:do c\u01a1 ch\u1ebf ph\u1ed1i h\u1ee3p l\u00fan v\u00e0 ng\u1eeda<\/p>\n

\u00b7 V\u00f9ng C3-C7:c\u00f3 c\u01a1 ch\u1ebf g\u00e2y c\u00e1c ki\u1ec3u g\u00e3y sau:<\/p>\n

– C\u01a1 ch\u1ebf g\u00e2y bong g\u00e2n nh\u1eb9 ho\u1eb7c n\u1eb7ng ,tr\u1eadt hai m\u1ea5u kh\u1edbp 2 b\u00ean.<\/p>\n

– C\u01a1 ch\u1ebf l\u00fan g\u00e2y g\u00e3y l\u00fan nhi\u1ec1u m\u1ea3nh.<\/p>\n

– C\u01a1 ch\u1ebf g\u1eadp v\u00e0 l\u00fan g\u00e2y g\u00e3y gi\u1ecdt l\u1ec7.<\/p>\n

– C\u01a1 ch\u1ebf xoay :g\u00e2y tr\u1eadt m\u1ea5u kh\u1edbp m\u1ed9t b\u00ean,g\u00e3y m\u1ea5u kh\u1edbp m\u1ed9t b\u00ean<\/p>\n

– C\u01a1 ch\u1ebf xoay k\u00e8m ng\u1eeda qu\u00e1 m\u1ee9c hay g\u1eadp l\u00fan th\u00ecnh l\u00ecnh g\u00e2y g\u00e3y r\u1eddi m\u1ea5u kh\u1edbp .<\/p>\n

– C\u01a1 ch\u1ebf ng\u1eeda g\u00e2y bong g\u00e2n nh\u1eb9 ho\u1eb7c n\u1eb7ng.<\/p>\n

– C\u01a1 ch\u1ebf ng\u1eeda k\u00e8m g\u1eadp g\u00e2y tr\u1eadt m\u1ea5u kh\u1edbp 2 b\u00ean .<\/p>\n

\u0110\u1ed1i v\u1edbi c\u1ed9t s\u1ed1ng l\u01b0ng \u2013 th\u1eaft l\u01b0ng.<\/p>\n

T\u00f9y l\u1ef1c ch\u1ea5n th\u01b0\u01a1ng t\u00e1c \u0111\u1ed9ng gi\u00e1n ti\u1ebfp ho\u1eb7c tr\u1ef1c ti\u1ebfp (\u0111a ph\u1ea7n l\u00e0 gi\u00e1n ti\u1ebfp) g\u00e2y n\u00ean c\u00e1c lo\u1ea1i g\u00e3y nh\u01b0 g\u00e3y l\u00fan ,g\u00e3y l\u00fan nhi\u1ec1u m\u1ea3nh ,g\u00e3y tr\u1eadt t\u00f9y thu\u1ed9c v\u00e0o t\u1eebng c\u01a1 th\u1ec3.<\/p>\n

C\u00e2u 13:ph\u00e2n t\u00edch 3 giai \u0111o\u1ea1n di\u1ec5n ti\u1ebfn c\u1ee7a bong g\u00e2n v\u1ec1 m\u1eb7t sinh l\u00fd b\u1ec7nh.<\/p>\n

Sau m\u1ed9t t\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng ta th\u1ea5y di\u1ec5n bi\u1ebfn ba giai \u0111o\u1ea1n (theo Oakes):<\/p>\n

– Giai \u0111o\u1ea1n vi\u00eam t\u1ea5y c\u1ea5p t\u00ednh: l\u00e2u kho\u1ea3ng 72h, th\u1ea5y c\u00f3 d\u1eadp v\u1ee1 c\u00e1c m\u1ea1ch m\u00e1u v\u00e0 s\u1ef1 ng\u1ea5m m\u00e1u ra tb<\/p>\n

– Giai \u0111o\u1ea1n ph\u1ee5c h\u1ed3i: di\u1ec5n ra t\u1eeb kho\u1ea3ng sau gi\u1edd 72 \u0111\u1ebfn 4 – 6 tu\u1ea7n l\u1ec5, c\u00f3 s\u1ef1 t\u00edch t\u1ee5 collagen t\u1ea1i v\u00f9ng bong g\u00e2n.<\/p>\n

– Giai \u0111o\u1ea1n t\u00e1i t\u1ea1o l\u1ea1i c\u00e1c d\u00e2y ch\u1eb1ng v\u00e0 c\u00e1c m\u00f4 kh\u00e1c: x\u1ea3y ra t\u1eeb tu\u1ea7n l\u1ec5 4 – 6 sau ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ebfn 3 – 6 th\u00e1ng (th\u1eadm ch\u00ed \u0111\u1ebfn 12 – 16 th\u00e1ng, [theo Sisk]) l\u00e0 th\u1eddi k\u1ef3 t\u1ed5 ch\u1ee9c l\u1ea1i collagen v\u00e0 c\u01a1.<\/p>\n

1. Giai \u0111o\u1ea1n vi\u00eam t\u1ea5y c\u1ea5p t\u00ednh<\/p>\n

Bi\u1ec3uhi\u1ec7n ch\u1ee7 y\u1ebfu b\u1eb1ng s\u1ef1 gi\u1eadp v\u1ee1 c\u00e1c m\u1ea1ch m\u00e1u nh\u1ecf, c\u00e1c h\u1ed3ng c\u1ea7u tho\u00e1t ra ngo\u00e0i m\u1ea1ch m\u00e1u v\u00e0 h\u00ecnh th\u00e0nh m\u00e1u c\u1ee5c c\u00f3 fibrin \u1edf v\u00f9ng bong g\u00e2n. Trong v\u00f2ng 36 gi\u1edd c\u00e1c b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n \u0111a h\u00ecnh d\u1ea1ng (polymorphonuclear monocytes) v\u00e0 c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o (macrophage) \u0111\u01b0\u1ee3c huy \u0111\u1ed9ng \u0111\u1ebfn v\u00f9ng b\u1ecb ch\u1ea5n th\u01b0\u01a1ng. C\u00e1c d\u01b0\u1ee1ng b\u00e0o (mast cells) v\u00e0 c\u00e1c t\u1ebf b\u00e0o kh\u00e1c ph\u00f3ng th\u00edch histamin serotonin v\u00e0 prostaglandin, do \u0111\u00f3 g\u00e2y ra s\u1ef1 duy tr\u00ec v\u00e0 tho\u00e1t r\u00f2 r\u1ec9 m\u00e1u ra ngo\u00e0i m\u1ea1ch. Bao kh\u1edbp ph\u1ea3n \u1ee9ng b\u1eb1ng hi\u1ec7n t\u01b0\u1ee3ng vi\u00eam bao kh\u1edbp v\u00f4 tr\u00f9ng sau ch\u1ea5n th\u01b0\u01a1ng, nh\u01b0 \u0111\u00e3 tr\u00ecnh b\u00e0y \u1edf tr\u00ean.<\/p>\n

2. Giai \u0111o\u1ea1n ph\u1ee5c h\u1ed3i<\/p>\n

Bi\u1ec3uhi\u1ec7n b\u1eb1ng hi\u1ec7n t\u01b0\u1ee3ng vi\u00eam t\u1ea5y ti\u00eau huy\u1ebft. C\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o s\u1ebd ti\u00eau h\u1ee7y c\u00e1c t\u1ebf b\u00e0o ch\u1ebft, h\u1ed3ng c\u1ea7u v\u00e0 m\u00e1u c\u1ee5c. \u0110\u1ed3ng th\u1eddi xu\u1ea5t hi\u1ec7n c\u00e1c ch\u1ed3i m\u1ea1ch m\u00e1u, t\u1eeb \u0111\u00f3 m\u00e0 h\u00ecnh th\u00e0nh c\u00e1c vi huy\u1ebft qu\u1ea3n m\u1edbi v\u00e0 c\u00f3 s\u1ef1 v\u1eadn chuy\u1ec3n nguy\u00ean b\u00e0o s\u1ee3i (fibroblast). C\u00e1c s\u1ee3i collagen \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh d\u1ea7n d\u1ea7n ph\u00ec \u0111\u1ea1i l\u00ean (t\u0103ng th\u00eam \u0111\u01b0\u1eddng k\u00ednh) v\u00e0 t\u0103ng d\u1ea7n c\u1ea3s\u1ee9c ch\u1ecbu \u0111\u1ef1ng k\u00e9o c\u0103ng t\u1ed1i thi\u1ec3u v\u00e0 c\u0169ng sau th\u1eddi gian \u0111\u00f3 c\u00e1c s\u1ee3i collagen m\u1edbi ch\u1ecbu \u0111\u01b0\u1ee3c s\u1ef1 k\u00e9o c\u0103ng m\u00e0 kh\u00f4ng b\u1ecb \u0111\u1ee9t l\u1ea1i. \u1ede th\u1eddi k\u1ef3 n\u00e0y c\u00e1c s\u1ee3i collagen ch\u01b0a ph\u00e1t tri\u1ec3n theo s\u1ef1 \u0111\u1ecbnh h\u01b0\u1edbng c\u1ee7a s\u1ee9c k\u00e9o c\u0103ng.<\/p>\n

3. Giai \u0111o\u1ea1n t\u00e1i t\u1ea1o d\u00e2y ch\u1eb1ng v\u00e0 c\u00e1c m\u00f4 kh\u00e1c<\/p>\n

Qu\u00e1 tr\u00ecnh ph\u00e1t tri\u1ec3n c\u00e1c s\u1ee3i collagen ti\u1ebfp t\u1ee5c t\u1eeb t\u1eeb k\u00e9o d\u00e0i \u0111\u1ebfn 12 \u2013 18 th\u00e1ng m\u1edbi ho\u00e0n th\u00e0nh. L\u00fac n\u00e0y c\u00e1c s\u1ee3i collagen m\u1edbi ph\u00e1t tri\u1ec3n theo \u0111\u00fang h\u01b0\u1edbng c\u1ee7a s\u1ef1 k\u00e9o c\u0103ng. S\u1ef1 ph\u00e1t tri\u1ec3n collagen \u0111\u1ecbnh h\u01b0\u1edbng ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang qui c\u00e1ch n\u00f3i tr\u00ean. N\u1ebfu \u0111i\u1ec1u tr\u1ecb sai qui c\u00e1ch, c\u00e1c s\u1ee3i collagen s\u1ebd ph\u00e1t tri\u1ec3n l\u1ed9n x\u1ed9n, kh\u00f4ng \u0111\u1ecbnh h\u01b0\u1edbng s\u1ebd g\u00e2y s\u1eb9o d\u00ednh. C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y cho th\u1ea5y t\u1eadp v\u1eadn \u0111\u1ed9ng th\u1eadn tr\u1ecdng, c\u00f3 h\u01b0\u1edbng d\u1eabn v\u00e0 c\u00f3 ki\u1ec3m so\u00e1t c\u0169ng nh\u01b0 ho\u1ea1t \u0111\u1ed9ng c\u01a1 h\u1ecdc (k\u00e9o c\u0103ng) t\u1ed1i thi\u1ec3u c\u00e1c d\u00e2y ch\u1eb1ng \u0111\u00fang th\u1eddi \u0111i\u1ec3m, s\u1ebd k\u00edch th\u00edch t\u1ed1t s\u1ef1 t\u1ed5ng h\u1ee3p v\u00e0 t\u00e1i t\u1ea1o c\u00e1c s\u1ee3i collagen c\u0169ng nh\u01b0 t\u0103ng c\u01b0\u1eddng s\u1ee9c ch\u1ecbu k\u00e9o c\u0103ng c\u1ee7a d\u00e2y ch\u1eb1ng.<\/p>\n

C\u00e2u 14: \u0110i\u1ec1u tr\u1ecb bong g\u00e2n:\u0110i\u1ec1u tr\u1ecb nh\u1eb1m hai m\u1ee5c \u0111\u00edch:<\/p>\n

– \u0110i\u1ec1u tr\u1ecb vi\u00eam t\u1ea5y c\u1ea5p t\u00ednh sau ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n

– Ph\u1ee5c h\u1ed3i v\u00e0 t\u00e1i t\u1ea1o c\u00e1c d\u00e2y ch\u1eb1ng (v\u00e0 c\u00e1c c\u01a1) b\u1ecb th\u01b0\u01a1ng. Nh\u01b0 v\u1eady \u0111\u1ed1i v\u1edbi bong g\u00e2n \u0111\u1ed9 l ch\u1ec9 ph\u1ea3i \u0111i\u1ec1u tr\u1ecb vi\u00eam c\u1ea5p t\u00ednh sau ch\u1ea5n th\u01b0\u01a1ng l\u00e0 \u0111\u1ee7, v\u00ec t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu d\u00e2y ch\u1eb1ng coi nh\u01b0 kh\u00f4ng \u0111\u00e1ng k\u1ec3. Ng\u01b0\u1ee3c l\u1ea1i \u0111\u1ed1i v\u1edbi bong g\u00e2n \u0111\u1ed9 2 ho\u1eb7c \u0111\u1ed9 3 ph\u1ea3i th\u1ef1c hi\u1ec7n \u0111\u1ea7y \u0111\u1ee7 c\u1ea3 hai y\u00eau c\u1ea7u. N\u1ebfu \u0111i\u1ec1u tr\u1ecb ph\u1ee5c h\u1ed3i v\u00e0 t\u00e1i t\u1ea1o d\u00e2y ch\u1eb1ng kh\u00f4ng t\u1ed1t th\u00ec vi\u00eam t\u1ea5y bao kh\u1edbp s\u1ebd th\u00e0nh m\u00e3n t\u00ednh v\u00e0 t\u1ed3n t\u1ea1i v\u0129nh vi\u1ec5n.<\/p>\n

1. \u0110i\u1ec1u tr\u1ecb vi\u00eam t\u1ea5y c\u1ea5p t\u00ednh bao kh\u1edbp<\/p>\n

– M\u1ee5c \u0111\u00edch l\u00e0 h\u1ea1n ch\u1ebf ch\u1ea3y m\u00e1u \u1edf m\u1ee9c \u0111\u1ed9 th\u1ea5p nh\u1ea5t, nh\u1edd v\u1eady m\u00e0 h\u1ea1n ch\u1ebf \u0111\u01b0\u1ee3c s\u1ef1 h\u00ecnh th\u00e0nh ph\u00f9 n\u1ec1 do tho\u00e1t m\u00e1u ra ngo\u00e0i m\u1ea1ch v\u00e0 ch\u1ed1ng \u0111au nh\u1ee9c. C\u1ee5 th\u1ec3 l\u00e0:<\/p>\n

– C\u00e1c \u0111i\u1ec1u n\u00ean l\u00e0m:<\/p>\n

+ \u0110\u1ec3 v\u00f9ng chi c\u00f3 bong g\u00e2n n\u1eb1m y\u00ean.<\/p>\n

+ Ch\u01b0\u1eddm \u0111\u00e1 l\u1ea1nh (n\u1ebfu kg c\u00f3: ch\u01b0\u1eddm n\u01b0\u1edbc l\u1ea1nh)gi\u00e3n c\u00e1ch nhau 20-30\u2019, trong 4h li\u1ec1n sau ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n

+ B\u0103ng \u00e9p li\u00ean t\u1ee5c \u00edt nh\u1ea5t 48 gi\u1edd.<\/p>\n

+ K\u00ea cao chi b\u1ecb th\u01b0\u01a1ng \u0111\u1ec3 k\u00edch th\u00edch l\u01b0u th\u00f4ng TM thu\u1eadn l\u1ee3i v\u00e0 l\u00e0m ti\u00eau h\u00fat nhanh ch\u00f3ng m\u00e1u t\u1ee5.<\/p>\n

+ D\u00f9ng c\u00e1c thu\u1ed1c ch\u1ed1ng vi\u00eam nh\u01b0 c\u00e1c lo\u1ea1i thu\u1ed1c phong b\u1ebf, ch\u1ed1ng ti\u1ebft prostaglandin ngay sau khi b\u1ecb ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c ch\u1eadm nh\u1ea5t trong v\u00f2ng 24 gi\u1edd \u0111\u1ec3 h\u1ea1n ch\u1ebf h\u00ecnh th\u00e0nh ph\u00f9 n\u1ec1.<\/p>\n

C\u00e1c bi\u1ec7n ph\u00e1p n\u00f3i tr\u00ean, nh\u1ea5t l\u00e0 ch\u01b0\u1eddm \u0111\u00e1 l\u1ea1nh, s\u1ebd l\u00e0m h\u1ebft \u0111au nhanh ch\u00f3ng.<\/p>\n

– C\u00e1c \u0111i\u1ec1u c\u1ea7n tr\u00e1nh, c\u1ea5m kh\u00f4ng \u0111\u01b0\u1ee3c l\u00e0m:<\/p>\n

+ Kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1eafp n\u00f3ng (b\u1ea5t k\u1ef3 b\u1eb1ng c\u00e1ch n\u00e0o), \u00edt nh\u1ea5t trong v\u00f2ng 42-78 gi\u1edd \u0111\u1ea7u sau ch\u1ea5n th\u01b0\u01a1ng. V\u00ec n\u00f3ng c\u0169ng l\u00e0m d\u1ecbu \u0111au, n\u00ean nhi\u1ec1u ng\u01b0\u1eddi th\u01b0\u1eddng m\u1eafc sai l\u1ea7m. N\u00f3ng s\u1ebd l\u00e0m gi\u00e3n m\u1ea1ch v\u00e0 c\u0169ng l\u00e0m t\u0103ng s\u1ef1 tho\u00e1t m\u00e1u ra ngo\u00e0i m\u1ea1ch v\u00e0 l\u00e0m t\u0103ng ph\u00f9 n\u1ec1.<\/p>\n

+ Kh\u00f4ng \u0111\u01b0\u1ee3c cho b\u1ec7nh nh\u00e2n u\u1ed1ng r\u01b0\u1ee3u, c\u0169ng l\u00e0 th\u1ee9 l\u00e0m gi\u00e3n m\u1ea1ch.<\/p>\n

+ Kh\u00f4ng \u0111\u01b0\u1ee3c ti\u00eam c\u00e1c thu\u1ed1c t\u00ea, lo\u1ea1i steroid, hyaluronidase ho\u1eb7c h\u1ed7n h\u1ee3p c\u00e1c ch\u1ea5t \u0111\u00f3 v\u00e0o v\u00f9ng bong g\u00e2n v\u00ec kh\u00f4ng c\u00f3 c\u01a1 s\u1edf sinh h\u1ecdc. C\u00e1c thu\u1ed1c n\u00f3i tr\u00ean \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c steroid, c\u00f3 th\u1ec3 l\u00e0m ch\u1eadm s\u1ef1 ph\u1ee5c h\u1ed3i collagen (Oakes). N\u1ebfu ti\u1ebfn h\u00e0nh k\u00e9m v\u00f4 tr\u00f9ng l\u1ea1i d\u1ec5 g\u00e2y nhi\u1ec5m tr\u00f9ng.<\/p>\n

+ Kh\u00f4ng \u0111\u01b0\u1ee3c xoa b\u00f3p, t\u1eadp v\u1eadn \u0111\u1ed9ng v\u00f9ng b\u1ecb bong g\u00e2n \u1edf giai \u0111o\u1ea1n vi\u00eam t\u1ea5y c\u1ea5p t\u00ednh. L\u00e0m nh\u01b0 v\u1eady ch\u1ec9 g\u00e2y th\u00eam t\u1ed5n th\u01b0\u01a1ng, l\u00e0m ch\u1ea3y m\u00e1u v\u00e0 ph\u00f9 n\u1ec1 th\u00eam.<\/p>\n

2. \u0110I\u1ec0U TR\u1eca PH\u1ee4C H\u1ed2I V\u00c0 T\u00c1I T\u1ea0O C\u00c1C D\u00c2Y CH\u1eb0NG<\/p>\n

C\u00e1ch t\u1ed1t nh\u1ea5t \u0111\u1ec3 c\u00e1c d\u00e2y ch\u1eb1ng b\u1ecb r\u00e1ch ho\u1eb7c \u0111\u1ee9t ph\u1ee5c h\u1ed3i l\u00e0 k\u00e9o cho c\u00e1c \u0111o\u1ea1n \u0111\u1ee9t \u00e1p s\u00e1t l\u1ea1i nhau \u0111\u1ec3 ph\u1ee5c h\u1ed3i \u0111\u01b0\u1ee3c \u0111\u00fang chi\u1ec1u d\u00e0i nguy\u00ean th\u1ee7y v\u00e0 b\u1ea5t \u0111\u1ed9ng b\u1ea3o v\u1ec7 ch\u1eebng n\u00e0o d\u00e2y ch\u1eb1ng c\u00f2n ch\u01b0a li\u1ec1n v\u1eefng. Nh\u01b0 v\u1eady \u0111\u1ed1i v\u1edbi bong g\u00e2n \u0111\u1ed9 2 ch\u1ec9 c\u1ea7n \u0111\u01a1n thu\u1ea7n b\u1ea5t \u0111\u1ed9ng b\u1ea3o v\u1ec7 \u0111\u1ee7 th\u1eddi gian (4-6 tu\u1ea7n l\u1ec5). \u0110\u1ed1i v\u1edbi bong g\u00e2n \u0111\u1ed9 3 t\u1ed1t nh\u1ea5t l\u00e0 ph\u1eabu thu\u1eadt s\u1edbm kh\u00e2u l\u1ea1i d\u00e2y ch\u1eb1ng v\u00e0 b\u1ea5t \u0111\u1ed9ng \u0111\u1ee7 th\u1eddi gian. Ch\u1ec9 \u0111\u01b0\u1ee3c cho t\u1eadp v\u1eadn \u0111\u1ed9ng s\u1edbm (sau 2 – 4 tu\u1ea7n l\u1ec5 sau m\u1ed5) n\u1ebfu \u0111\u01b0\u1ee3c k\u1ef9 thu\u1eadt vi\u00ean v\u1eadt l\u00fd c\u00f3 tr\u00ecnh \u0111\u1ed9 v\u00e0 kinh nghi\u1ec7m h\u01b0\u1edbng d\u1eabn v\u00e0 ki\u1ec3m so\u00e1t, l\u00e0m c\u00e1c v\u1eadn \u0111\u1ed9ng t\u1ed1i thi\u1ec3u v\u00e0 th\u1eadn tr\u1ecdng. N\u1ebfu l\u00e0m \u0111\u01b0\u1ee3c nh\u01b0 v\u1eady s\u1ef1 t\u00e1i t\u1ea1o d\u00e2y ch\u1eb1ng c\u00e0ng t\u1ed1t h\u01a1n.<\/p>\n

C\u00e2u 33: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 x\u1eed l\u00fd tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i?<\/p>\n

I. TRI\u1ec6U CH\u1ee8NG:<\/p>\n

* Tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i to\u00e0n b\u1ed9:<\/p>\n

1. C\u01a1 n\u0103ng:<\/p>\n

\u2013 \u0110au ch\u00f3i \u1edf ng\u1ef1c: xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t, b\u1ec7nh nh\u00e2n th\u1ea5y \u0111au ch\u00f3i \u1edf ng\u1ef1c, \u0111au nh\u01b0 x\u00e9 ph\u1ed5i.<\/p>\n

\u2013 Kh\u00f3 th\u1edf: xu\u1ea5t hi\u1ec7n ngay sau khi \u0111au ng\u1ef1c kh\u00f3 th\u1edf 2 th\u00ec, th\u1edf nhanh n\u00f4ng l\u01b0\u1ee3ng kh\u00ed tho\u00e1t v\u00e0o khoang m\u00e0ng ph\u1ed5i c\u00e0ng nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00e0ng kh\u00f3 th\u1edf.<\/p>\n

2. To\u00e0n th\u00e2n:<\/p>\n

– B\u1ec7nh nh\u00e2n th\u01b0\u1eddng trong t\u00ecnh tr\u1ea1ng s\u1ed1c: Da xanh t\u00e1i, v\u00e3 m\u1ed3 h\u00f4i, m\u1ea1ch nhanh, huy\u1ebft \u00e1p gi\u1ea3m.<\/p>\n

3. Th\u1ef1c th\u1ebf: Trong tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i to\u00e0n b\u1ed9 tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 th\u01b0\u1eddng r\u1ea5t r\u00f5 r\u00e0ng bi\u1ec3u hi\u1ec7n:<\/p>\n

– Nh\u00ecn: L\u1ed3ng ng\u1ef1c b\u00ean b\u1ecb tr\u00e0n kh\u00ed b\u1ea5t \u0111\u1ed9ng, c\u00e1c khoang li\u00ean s\u01b0\u1eddn gi\u00e3n r\u1ed9ng, l\u1ed3ng ng\u1ef1c c\u0103ng h\u01a1n b\u00ecnh th\u01b0\u1eddng, c\u00f3 s\u1ef1 co k\u00e9o c\u00e1c c\u01a1 h\u00f4 h\u1ea5p.<\/p>\n

– S\u1edd: rung thanh m\u1ea5t<\/p>\n

– G\u00f5: ti\u1ebfng g\u00f5 vang tr\u1ed1ng<\/p>\n

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

*M\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng do thay \u0111\u1ed5i v\u1ecb tr\u00ed c\u00e1c c\u01a1 quan: \u2013 M\u1ea5t v\u00f9ng \u0111\u1ee5c c\u1ee7a gan trong tr\u01b0\u1eddng h\u1ee3p tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i ph\u1ea3i.<\/p>\n

\u2013 M\u1ea5t ti\u1ebfng g\u00f5 \u0111\u1ee5c v\u00f9ng tr\u01b0\u1edbc tim trong tr\u01b0\u1eddng h\u1ee3p tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i tr\u00e1i.<\/p>\n

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

X quang l\u1ed3ng ng\u1ef1c t\u01b0 th\u1ebf th\u1eb3ng. Th\u1ea5y b\u00ean tr\u00e0n kh\u00ed c\u00f3 h\u00ecnh \u1ea3nh:<\/p>\n

\u2013 Ph\u1ebf tr\u01b0\u1eddng qu\u00e1 s\u00e1ng, m\u1ea5t h\u1ebft c\u00e1c v\u00e2n ph\u1ebf qu\u1ea3n.<\/p>\n

\u2013 Khoang li\u00ean s\u01b0\u1eddn gi\u00e3n, x\u01b0\u01a1ng s\u01b0\u1eddn n\u1eb1m ngang.<\/p>\n

\u2013 Ph\u1ed5i b\u1ecb \u00e9p l\u1ea1i th\u00e0nh m\u1ed9t c\u1ee5c x\u1eb9p s\u00e1t r\u1ed1n ph\u1ed5i. C\u00f3 hi\u1ec7n t\u01b0\u1ee3ng \u0111\u1ea9y: c\u01a1 ho\u00e0nh b\u1ecb \u0111\u1ea9y xu\u1ed1ng d\u01b0\u1edbi, trung th\u1ea5t b\u00ec \u0111\u1ea9y sang b\u00ean l\u00e0nh.<\/p>\n

*Tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i c\u1ee5c b\u1ed9:<\/p>\n

– Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng r\u1ea5t k\u00edn \u0111\u00e1o, th\u01b0\u1eddng kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c \u1edf c\u01a1 s\u1edf kh\u00f4ng c\u00f3 Xquang. N\u1ebfu ki\u1ec3m tra X quang c\u00f3 th\u1ec3 th\u1ea5y h\u00ecnh \u1ea3nh c\u1ee7a tr\u00e0n kh\u00ed c\u1ee5c b\u1ed9 l\u00e0 m\u1ed9t h\u00ecnh h\u01a1i (s\u00e1ng h\u01a1n b\u00ecnh th\u01b0\u1eddng) \u1edf r\u00eca ph\u1ed5i, gi\u1eefa nhu m\u00f4 ph\u1ed5i v\u00e0 l\u1ed3ng ng\u1ef1c.<\/p>\n

II. \u0110I\u1ec0U TR\u1eca: Tu\u1ef3 theo d\u1ea1ng l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh X quang v\u00e0 nguy\u00ean nh\u00e2n g\u00e2y tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i m\u00e0 \u0111i\u1ec1u tr\u1ecbcho th\u00edch h\u1ee3p.<\/p>\n

1. X\u1eed tr\u00ed tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i:<\/p>\n

1.1. Bi\u1ec7n ph\u00e1p kh\u00f4ng h\u00fat kh\u00ed, \u0111i\u1ec1u tr\u1ecb\u201cb\u1ea3o t\u1ed3n\u201d V\u1edbi bi\u1ec7n ph\u00e1p n\u00e0y kh\u00f4ng ch\u1ecdc h\u00fat kh\u00ed ch\u1ec9 theo d\u00f5i s\u1ef1 ti\u00eau d\u1ea7n c\u1ee7a kh\u00ed v\u00e0 n\u1edf l\u1ea1i c\u1ee7a ph\u1ed5i qua X quang v\u00e0 l\u00e2m s\u00e0ng.<\/p>\n

1.2. C\u00e1c ph\u01b0\u01a1ng th\u1ee9c x\u1eed l\u00fd b\u1eb1ng ch\u1ecdc h\u00fat, d\u1eabn l\u01b0u kh\u00ed:<\/p>\n

*Ch\u1ecdc kim: \u0110i\u1ec3m ch\u1ecdc \u1edf khoang li\u00ean s\u01b0\u1eddn 2 tr\u00ean \u0111\u01b0\u1eddng gi\u1eefa \u0111\u00f2n. \u1ede ph\u1ee5 n\u1eef v\u00ec v\u1ea5n \u0111\u1ec1 th\u1ea9m m\u1ef9 c\u00f3 th\u1ec3 ch\u1ecdc \u1ede \u0111\u01b0\u1eddng n\u00e1ch, ph\u00eda sau c\u01a1 ng\u1ef1c l\u1edbn. Lu\u00f4n \u0111i s\u00e1t b\u1edd tr\u00ean c\u1ee7a x\u01b0\u01a1ng s\u01b0\u1eddn d\u01b0\u1edbi.<\/p>\n

+ Tr\u00e0n kh\u00ed khu tr\u00fa: \u0110i\u1ec3m ch\u1ecdc h\u00fat, m\u1edf m\u00e0ng ph\u1ed5i: \u1edf v\u00f9ng c\u00f3 tr\u00e0n kh\u00ed<\/p>\n

2. C\u00e1c \u0111i\u1ec1u tr\u1ecb kh\u00e1c<\/p>\n

\u2013 Gi\u1ea3m \u0111au, ch\u1ed1ng s\u1ed1c: D\u00f9ng thu\u1ed1c an th\u1ea7n, gi\u1ea3m \u0111au. Kh\u00f4ng d\u00f9ng Morphin nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 kh\u1ea3 n\u0103ng suy h\u00f4 h\u1ea5p.<\/p>\n

\u2013 Li\u1ec7u ph\u00e1p oxy: N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf, suy h\u00f4 h\u1ea5p. \u2013 Kh\u00e1ng sinh.<\/p>\n

\u2013 C\u00e1c thu\u1ed1c kh\u00e1c: corticoid, long \u0111\u1eddm, tr\u1ee3tim\u2026n\u1ebfu ch\u1ea3y m\u00e1u, m\u1ea5t m\u00e1u: truy\u1ec1n d\u1ecbch, truy\u1ec1n m\u00e1u.<\/p>\n

C\u00e2u 46: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a tr\u00e0n m\u00e1u m\u00e0ng ph\u1ed5i<\/p>\n

Tr\u00e0n m\u00e1u m\u00e0ng ph\u1ed5i c\u00f3 th\u1ec3 nhi\u1ec1u m\u1ee9c \u0111\u1ed9, t\u1eeb r\u1ea5t \u00edt(v\u00e0i tr\u0103m ml) cho t\u1edbi r\u1ea5t nhi\u1ec1u(2 l\u00edt hay h\u01a1n n\u1eefa)<\/p>\n

I. L\u00e2m s\u00e0ng:<\/p>\n

1. To\u00e0n th\u00e2n:S\u1ed1t v\u00e0 c\u00e1c t\/c kh\u00e1c nh\u01b0: m\u1ea1ch nhanh, th\u1ec3 tr\u1ea1ng suy s\u1ee5p, m\u1ec7t m\u1ecfi<\/p>\n

2. C\u01a1 n\u0103ng:<\/p>\n

+\u0110au ng\u1ef1c: \u0111au nh\u00f3i, \u00e2m \u1ec9, d\u1ecbch nhi\u1ec1u \u0111\u1ee1 \u0111au, \u0111au giai \u0111o\u1ea1n vi\u00eam<\/p>\n

+Kh\u00f3 th\u1edf:t\u1ec9 l\u1ec7 thu\u1eadn v\u1edbi l\u01b0\u1ee3ng d\u1ecbch trong khoang m\u00e0ng ph\u1ed5i<\/p>\n

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

3. Th\u1ef1c th\u1ec3:\u21e8 H\u1ed9i ch\u1ee9ng 3 gi\u1ea3m<\/p>\n

– Nh\u00ecn:+L\u1ed3ng ng\u1ef1c b\u00ean c\u00f3 tr\u00e0n d\u1ecbch h\u01a1i nh\u00f4 cao h\u01a1n<\/p>\n

+Kho\u1ea3ng li\u00ean s\u01b0\u1eddn r\u1ed9ng h\u01a1n,<\/p>\n

+\u0110\u1ed9 di \u0111\u1ed9ng k\u00e9m h\u01a1n khi th\u1edf<\/p>\n

– S\u1edd: Rung thanh gi\u1ea3m ho\u1eb7c m\u1ea5t ho\u00e0n to\u00e0n.<\/p>\n

– 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\u1ecd m\u00e0ng ph\u1ed5i<\/p>\n

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

-X-quang:+L\u01b0\u1ee3ng \u00edt: <300ml \u2192 m\u1edd g\u00f3c s\u01b0\u1eddn ho\u00e0nh +L\u01b0\u1ee3ng v\u1eeba: 500 \u2013 1500 \u2192 \u0111\u01b0\u1eddng cong damoiseau +L\u01b0\u1ee3ng nhi\u1ec1u: >1500ml \u2192 m\u1edd ho\u00e0n to\u00e0n 1 b\u00ean ph\u1ed5i, trung th\u1ea5t b\u1ecb \u0111\u1ea9y sang b\u00ean l\u00e0nh<\/p>\n

-Si\u00eau \u00e2m: Ph\u00e1t hi\u1ec7n c\u00f3 d\u1ecbch<\/p>\n

M\u1ee9c \u0111\u1ed9 tr\u00e0n d\u1ecbch<\/p>\n

– Ch\u1ecdc d\u00f2 m\u00e0ng ph\u1ed5i:+L\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh TDMP<\/p>\n

+\u0110i\u1ec1u tr\u1ecb \u2192 ch\u1ecdc th\u00e1o \u0111\u1ec3 gi\u1ea3m \u00e1p<\/p>\n

+H\u01b0\u1edbng nguy\u00ean nh\u00e2n:M\u00e0u: V\u00e0ng chanh, h\u1ed3ng\/\u0111\u1ecf, m\u1ee7, tr\u1eafng \u0111\u1ee5c nh\u01b0 s\u1eefa<\/p>\n

XN: Sinh h\u00f3a, t\u1ebf b\u00e0o vi khu\u1ea9n<\/p>\n

III. H\u1eadu qu\u1ea3:<\/p>\n

– Sock<\/p>\n

– R\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p , suy h\u00f4 h\u1ea5p<\/p>\n

– R\u1ed1i lo\u1ea1n tu\u1ea7n h\u00f2an : h\u1ea1 huy\u1ebft \u00e1p , tr\u1ee5y tim m\u1ea1ch<\/p>\n

– Nhi\u1ec5m khu\u1ea9n m\u00e0ng ph\u1ed5i th\u1ee9 ph\u00e1t<\/p>\n

– D\u00e0y d\u00ednh , x\u01a1 h\u00f3a m\u00e0ng ph\u1ed5i<\/p>\n

C\u00e2u 34: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a, tri\u1ec7u ch\u1ee9ng v\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a m\u1ea3ng s\u01b0\u1eddn di \u0111\u1ed9ng?<\/p>\n

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

L\u00e0 m\u1ed9t v\u00f9ng n\u00e0o \u0111\u00f3 c\u1ee7a l\u1ed3ng ng\u1ef1c b\u1ecb m\u1ea5t li\u00ean t\u1ee5c v\u00e0 di \u0111\u1ed9ng ng\u01b0\u1ee3c chi\u1ec1u so v\u1edbi l\u1ed3ng ng\u1ef1c khi th\u1edf. \u0110i\u1ec1u ki\u1ec7n l\u00e0 x\u01b0\u01a1ng s\u01b0\u1eddn ph\u1ea3i b\u1ecb g\u00e3y 2 n\u01a1i tr\u00ean m\u1ed9t cung x\u01b0\u01a1ng v\u00e0 tr\u00ean 3 x\u01b0\u01a1ng s\u01b0\u1eddn k\u1ebf ti\u1ebfp nhau , c\u00e1c x\u01b0\u01a1ng g\u1eaby kh\u00f4ng c\u00e0i v\u00e0o nhau. Th\u01b0\u1eddng g\u1eb7p trong ch\u1ea5n th\u01b0\u01a1ng r\u1ea5t m\u1ea1nh. G\u00e2y r\u1ed1i lo\u1ea1n n\u1eb7ng n\u1ec1 v\u1ec1 h\u00f4 h\u1ea5p v\u00e0 tu\u1ea7n ho\u00e0n.<\/p>\n

II. Tri\u1ec7u ch\u1ee9ng<\/p>\n

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

– Ch\u1ea9n \u0111o\u00e1n m\u1ea3ng s\u01b0\u1eddn di \u0111\u1ed9ng d\u1ef1a tr\u00ean s\u1ef1 quan s\u00e1t th\u1ea5y m\u1ed9t v\u00f9ng th\u00e0nh ng\u1ef1c b\u1eadp b\u1ec1nh theo chi\u1ec1u ng\u01b0\u1ee3c v\u1edbi chi\u1ec1u chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a ph\u1ea7n th\u00e0nh ng\u1ef1c c\u00f2n l\u1ea1i khi BN h\u00f4 h\u1ea5p, c\u00f3 ngh\u0129a l\u00e0 m\u1ea3ng s\u01b0\u1eddn s\u1ebd d\u1ecbch chuy\u1ec3n ra ngo\u00e0i th\u00e0nh ng\u1ef1c khi BN th\u1edf ra v\u00e0 v\u00e0o ph\u00eda trong th\u00e0nh ng\u1ef1c khi BN h\u00edt v\u00e0o.<\/p>\n

– \u0110au, kh\u00f3 th\u1edf, th\u1edf nhanh v\u00e0 nh\u1ecbp tim nhanh l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng ph\u1ed5 bi\u1ebfn kh\u00e1c c\u1ee7a BN b\u1ecb m\u1ea3ng s\u01b0\u1eddn di \u0111\u1ed9ng. \u0110\u00f4i khi BN c\u00f3 bi\u1ec3u hi\u1ec7n th\u1edf g\u1eafng s\u1ee9c do ph\u1ea3i t\u0103ng c\u00f4ng h\u00f4 h\u1ea5p do m\u1ea3ng s\u01b0\u1eddn di \u0111\u1ed9ng g\u00e2y ra.<\/p>\n

– C\u00f3 khi t\u00edm t\u00e1i.<\/p>\n

– N\u1ebfu c\u00f3 tr\u00e0n kh\u00ed hay tr\u00e0n m\u00e1u m\u00e0ng ph\u1ed5i k\u00e8m theo th\u00ec c\u00f3 th\u00eam tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng 3 gi\u1ea3m hay h\u1ed9i ch\u1ee9ng 2 gi\u1ea3m 1 t\u0103ng<\/p>\n

+ X Quang:<\/p>\n

Th\u1ea5y \u0111\u01b0\u1ee3c g\u00e3y x\u01b0\u01a1ng s\u01b0\u1eddn 2 n\u01a1i v\u00e0 3 x\u01b0\u01a1ng li\u00ean ti\u1ebfp tr\u1edf l\u00ean ngo\u00e0i ra c\u00f2n th\u1ea5y \u0111\u01b0\u1ee3c tr\u00e0n d\u1ecbch hay tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i.<\/p>\n

III. H\u1eadu qu\u1ea3<\/p>\n

+ H\u00f4 h\u1ea5p \u0111\u1ea3o ng\u01b0\u1ee3c : Trong th\u00ec th\u1edf v\u00e0o, l\u1ed3ng ng\u1ef1c n\u1edf ra, \u00e1p l\u1ef1c trong khoang l\u1ed3ng ng\u1ef1c xu\u1ed1ng th\u1ea5p ,m\u1ea3ng s\u01b0\u1eddn b\u1ecb x\u1eadp v\u00e0o b\u00ean trong l\u00e0m cho ph\u1ed5i b\u1ecb \u00e9p l\u1ea1i. Trong th\u00ec th\u1edf ra, l\u1ed3ng ng\u1ef1c h\u1ea1 xu\u1ed1ng, \u00e1p l\u1ef1c trong khoang m\u00e0ng ph\u1ed5i t\u0103ng l\u00ean, m\u1ea3ng s\u01b0\u1eddn b\u1eadt ra ngo\u00e0i, ph\u1ed5i n\u1edf ra. H\u1eadu qu\u1ea3 c\u1ee7a hi\u1ec7n t\u01b0\u1ee3ng h\u00f4 h\u1ea5p \u0111\u1ea3o chi\u1ec1u l\u00e0m cho kh\u00f4ng kh\u00ed b\u1ecb lu\u1ea9n qu\u1ea9n gi\u1eefa hai ph\u1ed5i l\u00e0nh v\u00e0 ph\u1ed5i b\u1ecb t\u1ed5n th\u01b0\u01a1ng m\u00e0 kh\u00f4ng trao \u0111\u1ed5i kh\u00ed \u0111\u01b0\u1ee3c, g\u00e2y n\u00ean t\u00ecnh trang thi\u1ebfu oxy v\u00e0 \u1ee9 th\u00e1n kh\u00ed, d\u1eabn \u0111\u1ebfn suy h\u00f4 h\u1ea5p .<\/p>\n

+ L\u1eafc l\u01b0 trung th\u1ea5t : Khi m\u1ea3ng s\u01b0\u1eddn di \u0111\u00f4ng ng\u01b0\u1ee3c chi\u1ec1u v\u1edbi s\u1ef1 chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a l\u1ed3ng ng\u1ef1c ,s\u1ebd lu\u00f4n t\u00e1c \u0111\u1ed9ng m\u1ed9t l\u1ef1c l\u00fac m\u1ea1nh, l\u00fac nh\u1eb9 v\u00e0o trung th\u1ea5t ,l\u00e0m cho trung th\u1ea5t b\u1ecb l\u1eafc l\u01b0 ,g\u00e2y n\u00ean nh\u1eefng r\u1ed1i lo\u1ea1n n\u1eb7ng n\u1ec1 v\u1ec1 huy\u1ebft \u0111\u1ed9ng ,v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ng\u1eebng th\u1edf ,ng\u1eebng tim do ph\u1ea3n x\u1ea1.<\/p>\n

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

+ Tr\u00e0n m\u00e1u m\u00e0ng ph\u1ed5i<\/p>\n

+ T\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 ph\u1ed5i<\/p>\n

C\u00e2u 41: Tr\u00ecnh b\u00e0y c\u00e1c r\u1ed1i lo\u1ea1n ti\u1ec3u ti\u1ec7n khi kh\u00e1m h\u1ec7 ti\u1ebft ni\u1ec7u?<\/p>\n

1.H\u1ed9i ch\u1ee9ng b\u00e0ng quang k\u00edch th\u00edch:<\/p>\n

-Ti\u1ec3u d\u1eaft: ti\u1ec3u nhi\u1ec1u l\u1ea7n trong ng\u00e0y, m\u1ed7i l\u1ea7n \u00edt n\u01b0\u1edbc ti\u1ec3u nh\u1ea5t l\u00e0 ban \u0111\u00eam. C\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi\u0111\u00e1i th\u00e1o nh\u1ea1t l\u00e0 ti\u1ec3u nhi\u1ec1u.<\/p>\n

-Ti\u1ec3u bu\u1ed1t: c\u1ea3m gi\u00e1c \u0111au r\u00e1t b\u1ecfng khi ti\u1ec3u, th\u01b0\u1eddng k\u00e8m \u0111\u00e1i d\u1eaft. C\u01a1n \u0111au bu\u1ed1t c\u00f3 khi to\u00e0n b\u1ed9th\u1eddi gian \u0111i ti\u1ec3u ho\u1eb7c ch\u1ec9 l\u00fac \u0111\u1ea7u<\/p>\n

-Nguy\u00ean nh\u00e2n: b\u00e0ng quang b\u1ecb k\u00edch th\u00edch do vi\u00eam, d\u1ecb v\u1eadt, ph\u00ec \u0111\u1ea1i ti\u1ec1n li\u1ec7t tuy\u1ebfn k\u00edch th\u00edch c\u1ed5b\u00e0ng quang. C\u00f3 khi u ti\u1ec3u khung, c\u00e1c b\u1ec7nh l\u00fd ti\u1ec3u khung ho\u1eb7c s\u1ecfi ni\u1ec7u qu\u1ea3n s\u00e1t th\u00e0nh b\u00e0ngquang.<\/p>\n

2.H\u1ed9i ch\u1ee9ng t\u1eafc ngh\u1ebdn:<\/p>\n

-Ti\u1ec3u kh\u00f3: l\u00fac \u0111\u1ea7u b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1i \u0111\u01b0\u1ee3c ngay, ph\u1ea3i r\u1eb7n, tia n\u01b0\u1edbc ti\u1ec3u y\u1ebfu, th\u1eddi gian \u0111iti\u1ec3u l\u00e2u. Sau khi ti\u1ec3u xong kh\u00f4ng c\u00f3 c\u1ea3m gi\u00e1c tho\u1ea3i m\u00e1i. Nguy\u00ean nh\u00e2n do c\u00e1c b\u1ec7nh l\u00fd v\u00f9ngc\u1ed5 b\u00e0ng quang v\u00e0 ni\u1ec7u \u0111\u1ea1o nh\u01b0 ph\u00ec \u0111\u1ea1i ti\u1ec1n li\u1ec7t tuy\u1ebfn, co th\u1eaft c\u1ed5 b\u00e0ng quang, x\u01a1 c\u1ee9ng c\u1ed5b\u00e0ng quang, s\u1ecfi b\u00e0ng quang, h\u1eb9p ni\u1ec7u \u0111\u1ea1o. H\u1eadu qu\u1ea3 giai \u0111o\u1ea1n \u0111\u1ea7u b\u00e0ng quang d\u00e0y l\u00ean dot\u0103ng co b\u00f3p, giai \u0111o\u1ea1n sau c\u01a1 b\u00e0ng quang nh\u00e3o, \u1ee9 \u0111\u1ecdng n\u01b0\u1edbc ti\u1ec3u d\u1eabn \u0111\u1ebfn nhi\u1ec5m khu\u1ea9n ti\u1ebftni\u1ec7u.<\/p>\n

-B\u00ed \u0111\u00e1i: l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng c\u00f3 n\u01b0\u1edbc ti\u1ec3u trong b\u00e0ng quang nh\u01b0ng b\u1ec7nh nh\u00e2n kh\u00f4ng ti\u1ec3u ra \u0111\u01b0\u1ee3c(c\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi v\u00f4 ni\u1ec7u: b\u00e0ng quang kh\u00f4ng c\u00f3 n\u01b0\u1edbc ti\u1ec3u)<\/p>\n

+B\u00ed \u0111\u00e1i ho\u00e0n to\u00e0n: b\u1ec7nh nh\u00e2n c\u0103ng t\u1ee9c tr\u00ean x\u01b0\u01a1ng mu, bu\u1ed3n ti\u1ec3u d\u1eef d\u1ed9i nh\u01b0ng kh\u00f4ng ti\u1ec3u\u0111\u01b0\u1ee3c. Kh\u00e1m th\u1ea5y c\u1ea7u b\u00e0ng quang: kh\u1ed1i c\u0103ng tr\u00ean x\u01b0\u01a1ng mu, gi\u1edbi h\u1ea1n r\u00f5, g\u00f5 \u0111\u1ee5c h\u00ecnhparabol \u0111\u1ec9nh quay l\u00ean tr\u00ean, \u1ea5n v\u00e0o g\u00e2y c\u1ea3m gi\u00e1c bu\u1ed3n \u0111i ti\u1ec3u.<\/p>\n

+B\u00ed \u0111\u00e1i kh\u00f4ng ho\u00e0n to\u00e0n: b\u00e0ng quang lu\u00f4n \u1ee9 \u0111\u1ecdng n\u01b0\u1edbc ti\u1ec3u >300ml.<\/p>\n

-Ti\u1ec3u kh\u00f4ng t\u1ef1 ch\u1ee7: n\u01b0\u1edbc ti\u1ec3u r\u1ec9 ra ngo\u00e0i \u00fd mu\u1ed1n b\u1ec7nh nh\u00e2n<\/p>\n

+R\u1ec9 n\u01b0\u1edbc ti\u1ec3u li\u00ean t\u1ee5c: r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 th\u1eaft b\u00e0ng quang ni\u1ec7u \u0111\u1ea1o do t\u1ed5n th\u01b0\u01a1ng n\u00e1o,sau m\u1ed5 ti\u1ec1n li\u1ec7t tuy\u1ebfn.<\/p>\n

+\u0110\u00e1i r\u1ec9 g\u1eafn s\u1ee9c: n\u01b0\u1edbc ti\u1ec3u r\u1ec9 ra ngo\u00e0i \u00fd mu\u1ed1n b\u1ec7nh nh\u00e2n khi c\u00f3 ho\u1ea1t \u0111\u1ed9ng g\u1eafn s\u1ee9c.<\/p>\n

3. \u0110\u00e1i m\u00e1u:<\/p>\n

N\u01b0\u1edbc ti\u1ec3u \u0111\u1ecf c\u00f3 h\u1ed3ng c\u1ea7u, c\u1eb7n addis > 500000HC\/ph\u00fat. Ta c\u1ea7n xem n\u01b0\u1edbc ti\u1ec3u m\u00e0u h\u1ed3ng, \u0111\u1ecf t\u01b0\u01a1i, hay \u0111\u1ecf th\u1eabm c\u00f3 m\u00e1u c\u1ee5c kh\u00f4ng, ti\u1ec3u \u0111\u1ecf c\u00f3 v\u1ea9n \u0111\u1ee5c v\u00e1ng m\u1ee1 kh\u00f4ng, \u0111\u00e1i m\u00e1u d\u01b0\u1ee1ng ch\u1ea5p, ti\u1ec3u \u0111\u1ecf c\u00f3 l\u1eabn ch\u1ea5t nh\u1ea7y nh\u01b0 l\u00f2ng tr\u1eafng tr\u1ee9ng kh\u00f4ng, ph\u1ea3i khai th\u00e1c b\u1ec7nh s\u1eed( th\u1eddi gian, tri\u1ec7u ch\u1ee9ng, di\u1ec5n ti\u1ebfn )<\/p>\n

-Nghi\u1ec7m ph\u00e1p ba c\u1ed1c: \u0111\u00e1i m\u00e1u \u0111\u1ea7u b\u00e3i l\u00e0 th\u01b0\u01a1ng t\u1ed5n ni\u1ec7u \u0111\u1ea1o, cu\u1ed1i b\u00e3i l\u00e0 th\u01b0\u01a1ng t\u1ed5n \u1edf b\u00e0ng quang, to\u00e0n b\u00e3i l\u00e0 th\u01b0\u01a1ng t\u1ed5n \u1edf th\u1eadn. Ch\u00fa \u00fd th\u01b0\u01a1ng t\u1ed5n b\u00e0ng quang n\u1eb7ng c\u0169ng c\u00f3 th\u1ec3 g\u00e2y \u0111\u00e1i m\u00e1u to\u00e0n b\u00e3i.<\/p>\n

4. \u0110\u00e1i m\u1ee7:<\/p>\n

N\u01b0\u1edbc ti\u1ec3u c\u00f3 m\u1ee7 t\u1eafng \u0111\u1ee5c, c\u1eb7n Addis 5000\/ph\u00fat( ph\u00e2n bi\u1ec7t v\u1edbi ti\u1ec3u c\u1eb7n phosphat, ti\u1ec3u albumin, ti\u1ec3u c\u1eb7n urat). Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nhi\u1ec5m khu\u1ea9n h\u1ec7 ni\u1ec7u do s\u1ecfi v\u00e0 d\u1ecb d\u1ea1ng b\u1ea9m sinh \u0111\u01b0\u1eddng ni\u1ec7u.<\/p>\n

C\u00e2u 32: Tr\u00ecnh b\u00e0y c\u00e1c CLS trong th\u0103m kh\u00e1m h\u1ec7 ti\u1ebft ni\u1ec7u sinh d\u1ee5c?<\/p>\n

I. X\u00e9t nghgi\u1ec7m:<\/p>\n

– Ure \u2013 creatinin, \u0111\u00e1nh gi\u00e1 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn th\u1eadn gi\u00fap \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n

– C\u1ea7n thi\u1ebft c\u00f3 th\u1ec3 l\u00e0m \u0111i\u1ec7nG\u0110, d\u1ef1 tr\u1eef ki\u1ec1m,pH m\u00e1u.<\/p>\n

– X\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u: s\u1ed1 l\u01b0\u1ee3ng vi khu\u1ea9n, l\u00e0m kh\u00e1ng sinh \u0111\u1ed3, soi t\u01b0\u01a1i.<\/p>\n

II. Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh:<\/p>\n

– Ch\u1ee5p K.U.B: c\u00f3 th\u1ec3 th\u1ea5y b\u00f3ng th\u1eadn b\u00ecnh th\u01b0\u1eddng ho\u1eb7c bi\u1ebfn d\u1ea1ng, h\u00ecnh \u1ea3nh c\u1ea3n quang \u0111\u01b0\u1eddng ni\u1ec7u.<\/p>\n

– Ch\u1ee5p UIV: nh\u1eb1m \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c ch\u1ee9c n\u0103ng th\u1eadn c\u00e1c d\u1ecb d\u1ea1ng \u0111\u01b0\u1eddng ni\u1ec7u, s\u1ecfi h\u1ec7 ni\u1ec7u.<\/p>\n

– Ch\u1ee5pUPR: soi b\u00e0ng quang qua ni\u1ec7u \u0111\u1ea1o t\u00ecm l\u1ed7 ni\u1ec7u qu\u1ea3n \u0111\u1eb7t n\u00f2ng b\u01a1m thu\u1ed1c c\u1ea3n quang r\u1ed3i ch\u1ee5p. Ch\u1ec9 \u0111\u1ecbnh khi UIV th\u1eadn kh\u00f4ng ng\u1ea5m thu\u1ed1c, h\u00ecnh \u1ea3nh b\u1ec3 th\u1eadn, ni\u1ec7u qu\u1ea3n kh\u00f4ng r\u00f5 r\u00e0ng, c\u1ea7n t\u00ecm c\u00e1c l\u1ed7 r\u00f2 t\u1eeb th\u1eadn sang \u0111\u01b0\u1eddng b\u1ea1ch huy\u1ebft.<\/p>\n

– Ch\u1ee5p UPD: ch\u1ec9 \u0111\u1ecbnh khi t\u1eafc ni\u1ec7u qu\u1ea3n v\u00e0 th\u1eadn \u0111\u01b0\u1ee3c d\u1eabn l\u01b0u b\u1eb1ng \u1ed1ng th\u00f4ng.<\/p>\n

– Ch\u1ee5p b\u00e0ng quang ng\u01b0\u1ee3c d\u00f2ng: \u0111\u1eb7t sonde v\u00e0o b\u00e0ng quang, b\u01a1m thu\u1ed1c c\u1ea3n quang r\u1ed3i ch\u1ee5p.<\/p>\n

– Ch\u1ee5p ni\u1ec7u \u0111\u1ea1o ng\u01b0\u1ee3c d\u00f2ng: b\u01a1m thu\u1ed1c c\u1ea3n quang ng\u01b0\u1ee3c d\u00f2ng t\u1eeb mi\u1ec7ng s\u00e1o r\u1ed3i ch\u1ee5p. Th\u01b0\u1eddng d\u00f9ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n h\u1eb9p ni\u1ec7u \u0111\u1ea1o, r\u00f2 ni\u1ec7u \u0111\u1ea1o, t\u00fai th\u1eeba ni\u1ec7u \u0111\u1ea1o, c\u00e1c bi\u1ebfn d\u1ea1ng ni\u1ec7u \u0111\u1ea1o.<\/p>\n

– Ch\u1ee5p CT Scanner: cho th\u1ea5y r\u00f5 c\u00e1c kh\u1ed1i u \u1edf th\u1eadn, b\u00e0ng quang, s\u1ecfi, nang th\u1eadn.<\/p>\n

– Ch\u1ee5p h\u1ec7 b\u1ea1ch m\u1ea1ch: t\u00ecm c\u00e1c h\u1ea1ch b\u1ec7nh l\u00fd trong ung th\u01b0, tuy nhi\u00ean kh\u00f3 th\u1ef1c hi\u1ec7n.<\/p>\n

– Ch\u1ee5p MRI: \u00edt d\u00f9ng trong h\u1ec7 ni\u1ec7u v\u00ec cho h\u00ecnh \u1ea3nh t\u01b0\u01a1ng t\u1ee5 CT Scanner.<\/p>\n

– Ch\u1ee5p t\u0129nh m\u1ea1ch ch\u1ee7: ch\u1ec9 \u0111\u1ecbnh khi<\/p>\n

+ Ph\u00e1t hi\u1ec7n c\u1ee5c m\u00e1u \u0111\u00f4ng trong t\u0129nh m\u1ea1ch th\u1eadn<\/p>\n

+ Nghi\u00ean c\u1ee9u s\u1ef1 li\u00ean quan gi\u1eefa u th\u1eadn v\u00e0 TM ch\u1ee7.<\/p>\n

– Si\u00eau \u00e2m: cho bi\u1ebft h\u00ecnh th\u00e1i c\u1ee7a th\u1eadn, ni\u1ec7u qu\u1ea3n, b\u00e0ng quang, s\u1ecfi ni\u1ec7u, ti\u1ec1n li\u1ec7t tuy\u1ebfn, tinh ho\u00e0n.<\/p>\n

– N\u1ed9i soi ni\u1ec7u \u0111\u1ea1o, b\u00e0ng quang, ni\u1ec7u qu\u1ea3n gi\u00fap ph\u00e1t hi\u1ec7n u, s\u1ecfi.<\/p>\n

C\u00e2u 22: H\u00e3y n\u00eau c\u00e1c n\u1ed9i dung chu\u1ea9n b\u1ecb BN tr\u01b0\u1edbc m\u1ed5; \u00fd ngh\u0129a c\u1ee7a vi\u1ec7c chu\u1ea9n b\u1ecb n\u00e0y.<\/p>\n

I. N\u1ed9i dung chu\u1ea9n b\u1ecb BN tr\u01b0\u1edbc m\u1ed5:<\/p>\n

– Vi\u1ec7c l\u00ean k\u1ebf ho\u1ea1ch v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ed9t c\u00e1ch th\u00edch h\u1ee3p \u1edf m\u1ed7i BN chu\u1ea9n b\u1ecb \u0111\u01b0\u1ee3c ph\u1ea9u thu\u1eadt l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o cho k\u1ebft qu\u1ea3 \u0111\u01b0\u1ee3c t\u1ed1t nh\u1ea5t.<\/p>\n

– Trong qu\u00e1 tr\u00ecnh n\u00e0y BN c\u1ea7n \u0111\u01b0\u1ee3c:<\/p>\n

+ Treo d\u00f5i \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng s\u1ee9c kho\u1ebb (th\u00f4ng qua b\u1ec7nh s\u1eed kh\u00e1m l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m)<\/p>\n

+ X\u00e1c \u0111\u1ecbnh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/p>\n

+ \u0110\u01b0\u1ee3c t\u01b0 v\u1ea5n b\u1edfi c\u00e1c chuy\u00ean khoa kh\u00e1c (tu\u1ef3 theo b\u1ec7nh \u0111i k\u00e8m)<\/p>\n

+ \u0110\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 v\u1ec1 r\u1ee7i ro trong ph\u1ea9u thu\u1eadt v\u00e0 g\u00e2y m\u00ea<\/p>\n

+ C\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m ti\u1ec1n ph\u1ea9u \u0111\u1ec3 h\u1ed5 tr\u1ee3 cho vi\u1ec7c l\u01b0\u1ee3ng gi\u00e1.<\/p>\n

+ D\u1eb7n d\u00f2 BN gi\u1ea3i quy\u1ebft nh\u1eefng m\u1ed1i quan t\u00e2m c\u1ee7a BN c\u0169ng nh\u01b0 t\u1ea1o s\u1ef1 tin c\u1eady gi\u1eefa BN v\u00e0 b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

II. \u00dd ngh\u0129a c\u1ee7a vi\u1ec7c chu\u1ea9n b\u1ecb n\u00e0y:<\/p>\n

N\u1ebfu kh\u00f4ng c\u00f3 h\u1ebf ho\u1ea1ch tr\u01b0\u1edbc ph\u1ea9u thu\u1eadt th\u00edch h\u1ee3p:<\/p>\n

+ BN kh\u00f4ng \u0111\u1ee7 s\u1ee9c kho\u1ebb cho cu\u1ed9c ph\u1ea9u thu\u1eadt (do kh\u00f4ng \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c theo d\u00f5i t\u1ed1t, do nh\u1eefng x\u00e9t nghi\u1ec7m c\u1ea7n thi\u1ebft c\u00f3 th\u1ec3 b\u1ecb b\u1ecf s\u00f3t) c\u0169ng nh\u01b0 kh\u00f4ng \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n \u0111\u1ec3 g\u00e2y m\u00ea. T\u1eeb \u0111\u00f3 l\u00e0m ch\u1eadm tr\u1ec5 ho\u1eb7c hu\u1ef7 b\u1ecf cu\u1ed9c ph\u1ea9u thu\u1eadt.<\/p>\n

+ G\u00e2y ra nh\u1eefng c\u0103ng th\u1eb3ng cho BN v\u00e0 ng\u01b0\u1eddi nh\u00e0.<\/p>\n

+ t\u0103ng chi ph\u00ed cho c\u1ea3 BN l\u1eabn b\u1ec7nh vi\u1ec7n.<\/p>\n

C\u00e2u 23:Tr\u00ecnh b\u00e0y ch\u0103m s\u00f3c BN sau m\u1ed5 t\u1ea1i ph\u00f2ng h\u1eadu ph\u1ea9u?I. \u0110i\u1ec1u ki\u1ec7n \u0111\u1ec3 chuy\u1ec3n BN v\u1ec1 ph\u00f2ng h\u1eadu ph\u1eabu:<\/p>\n

– BN \u0111\u00e3 t\u1ec9nh t\u00e1o ho\u00e0n to\u00e0n.<\/p>\n

– BN c\u00f3 th\u1ec3 t\u1ef1 \u0111\u1ea3m b\u1ea3o m\u1ed9t t\u01b0 th\u1ebf an to\u00e0n v\u00e0 tho\u1ea3i m\u00e1i tr\u00ean gi\u01b0\u1eddng b\u1ec7nh.<\/p>\n

– Huy\u1ebft \u00e1p t\u00e2m thu l\u1edbn h\u01a1n hay b\u1eb1ng 100 mmHg.<\/p>\n

– T\u00f9y thu\u1ed9c v\u00e0o b\u1ec7nh l\u00fd, ph\u01b0\u01a1ng ph\u00e1p g\u00e2y m\u00ea v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ph\u1eabu thu\u1eadt m\u00e0 c\u00e1c BN s\u1ebd \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c v\u1ec1 m\u1eb7t v\u1eadn \u0111\u1ed9ng kh\u00e1c nhau. N\u1ebfu ph\u1eabu thu\u1eadt v\u00f9ng b\u1ee5ng c\u00f3 g\u00e2y m\u00ea to\u00e0n th\u00e2n, sau khi chuy\u1ec3n BN v\u1ec1 ph\u00f2ng h\u1eadu ph\u1eabu, cho BN n\u1eb1m ngh\u1ec9 d\u01b0\u1ee1ng \u1edf t\u01b0 th\u1ebf Fowler. T\u01b0 th\u1ebf Fowler c\u0169ng th\u00edch h\u1ee3p cho BN sau ph\u1eabu thu\u1eadt l\u1ed3ng ng\u1ef1c.<\/p>\n

– Tr\u1eeb m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t, BN s\u1ebd \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u ng\u1ed3i d\u1eady v\u00e0o bu\u1ed5i t\u1ed1i c\u1ee7a ng\u00e0y ph\u1eabu thu\u1eadt v\u00e0 \u0111i l\u1ea1i v\u00e0o ng\u00e0y h\u00f4m sau. Sau 3-5 ng\u00e0y sau m\u1ed5, BN s\u1ebd \u0111i l\u1ea1i b\u00ecnh th\u01b0\u1eddng.<\/p>\n

II. Bi\u1ebfn ch\u1ee9ng H\u00f4 h\u1ea5p:\u0110\u1ec3 ng\u0103n ng\u1eeba bi\u1ebfn ch\u1ee9ng h\u00f4 h\u1ea5p c\u00f3 th\u1ec3 x\u1ea3y ra sau m\u1ed5, c\u1ea7n th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p sau:<\/p>\n

+ H\u1ea1n ch\u1ebf vi\u1ec7c n\u1eb1m b\u1ea5t \u0111\u1ed9ng k\u00e9o d\u00e0i, \u0111\u1eb7c bi\u1ec7t n\u1eb1m ng\u1eefa th\u1eb3ng tr\u00ean gi\u01b0\u1eddng. C\u1ea7n thay \u0111\u1ed5i t\u01b0 th\u1ebf th\u01b0\u1eddng xuy\u00ean.<\/p>\n

+ T\u1eadp th\u1edf s\u00e2u \u0111\u1ec3 t\u0103ng c\u01b0\u1eddng ho\u1ea1t \u0111\u1ed9ng c\u01a1 ho\u00e0nh<\/p>\n

+ T\u1eadp ho kh\u1ea1c.<\/p>\n

+ Ph\u1ebf dung khuy\u1ebfn kh\u00edch BN \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch h\u00edt s\u00e2u, sao cho qu\u1ea3 b\u00f3ng \u0111\u01b0\u1ee3c n\u00e2ng l\u00ean t\u1edbi m\u1ed9t \u0111\u1ecd cao cho tr\u01b0\u1edbc.<\/p>\n

+ Tr\u00e1nh truy\u1ec1n qu\u00e1 nhi\u1ec1u d\u1ecbch. N\u1ebfu kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh kh\u00e1c, th\u00f4ng ti\u1ec3u \u0111\u01b0\u1ee3c r\u00fat khi BN b\u1eaft \u0111\u1ea7u ng\u1ed3i d\u1eady.III. V\u1ea5n \u0111\u1ec1 \u0103n u\u1ed1ng:<\/p>\n

– Cho \u0103n khi BN t\u1ec9nh t\u00e1o ho\u00e0n to\u00e0n v\u00e0 \u0111\u01b0\u1eddng ti\u00eau ho\u00e1 b\u1eaft \u0111\u1ea7u ho\u1ea1t \u0111\u1ed9ng.<\/p>\n

– C\u00f3 nhu \u0111\u1ed9ng ru\u1ed9t, BN \u0111\u00f3i b\u1ee5ng: cho u\u1ed1ng d\u1ecbch lo\u00e3ng. Tr\u00e1nh c\u00e1c ch\u1ea5t sinh h\u01a1i hay c\u1ea7n nhi\u1ec1u n\u0103ng l\u01b0\u1ee3ng \u0111\u1ec3 ti\u00eau ho\u00e1 (m\u1ee1).<\/p>\n

– Khi c\u00f3 trung ti\u1ec7n, cho BN \u0103n \u0111\u1eb7c d\u1ea7n v\u1edbi s\u1ed1 l\u01b0\u1ee3ng t\u0103ng d\u1ea7n<\/p>\n

IV. Gi\u1ea3m \u0111au sau m\u1ed5:<\/p>\n

– Gi\u1ea3m \u0111au t\u1ed1t sau m\u1ed5 s\u1ebd h\u1ea1n ch\u1ebf \u0111\u01b0\u1ee3c nguy c\u01a1 x\u1ea3y ra c\u00e1c bi\u1ebfn ch\u1ee9ng sau m\u1ed5:<\/p>\n

+ Thi\u1ebfu m\u00e1u c\u01a1 tim, nh\u1ed3i m\u00e1u c\u01a1 tim<\/p>\n

+ Nh\u1ecbp tim nhanh v\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/p>\n

+ Ch\u1eadm l\u00e0nh v\u1ebft th\u01b0\u01a1ng<\/p>\n

+ X\u1eb9p ph\u1ed5i, vi\u00eam ph\u1ed5i<\/p>\n

+ Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch<\/p>\n

+ Co th\u1eaft m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean<\/p>\n

+ Nhi\u1ec5m toan chuy\u1ec3n ho\u00e1<\/p>\n

– Acetaminophene: M\u1ed9t s\u1ed1 v\u1ea5n \u0111\u1ec1 c\u1ea7n ch\u00fa \u00fd khi ch\u1ec9 \u0111\u1ecbnh acetaminophene \u0111\u1ec3 gi\u1ea3m \u0111au h\u1eadu ph\u1eabu:<\/p>\n

+ Acetaminophene c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au, h\u1ea1 s\u1ed1t nh\u01b0ng kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng vi\u00eam.<\/p>\n

+ Acetaminophene kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u, kh\u00f4ng l\u00e0m t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u.<\/p>\n

+ Acetaminophene c\u00f3 \u0111\u1ed9c t\u00ednh tr\u00ean gan. Li\u1ec1u 10-15g acetaminophene c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ho\u1ea1i t\u1eed gan.<\/p>\n

+ Li\u1ec1u s\u1eed d\u1ee5ng: 325-1000 mg m\u1ed7i 4-6 gi\u1edd. Li\u1ec1u t\u1ed1i \u0111a: 4000 mg\/ng\u00e0y.<\/p>\n

C\u00e2u 39: Tr\u00ecnh b\u00e0y c\u00e1ch ph\u00e2n khu v\u00f9ng b\u1ee5ng v\u00e0 c\u00e1c \u0111i\u1ec3m \u0111au \u1edf th\u00e0nh b\u1ee5ng?<\/p>\n

*C\u00e1c khu th\u00e0nh b\u1ee5ng tr\u01b0\u1edbc<\/p>\n

C\u00f3 hai c\u00e1ch ph\u00e2n khu v\u00f9ng b\u1ee5ng<\/p>\n

A. C\u00e1ch chia th\u00e0nh 4 v\u00f9ng<\/p>\n

K\u1ebb hai \u0111\u01b0\u1eddng vu\u00f4ng g\u00f3c \u0111i qua r\u1ed1n m\u1ed9t \u0111\u01b0\u1eddng d\u1ecdc v\u00e0 m\u1ed9t \u0111\u01b0\u1eddng ngang. Hai \u0111\u01b0\u1eddng n\u00e0y chia th\u00e0nh b\u1ee5ng tr\u01b0\u1edbc th\u00e0nh b\u1ed1n khu<\/p>\n

-Khu tr\u00ean ph\u1ea3i:Thu\u1ef3 gan ph\u1ea3i, t\u00fai m\u1eadt, m\u00f4n v\u1ecb, t\u00e1 tr\u00e0ng, \u0111\u1ea7u tu\u1ef5, tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn ph\u1ea3i, ph\u1ea7n tr\u00ean th\u1eadn ph\u1ea3i, g\u00f3c gan c\u1ee7a \u0111\u1ea1i tr\u00e0ng, m\u1ed9t \u0111o\u1ea1n c\u1ee7a \u0111\u1ea1i tr\u00e0ng tr\u00ean v\u00e0 ngang<\/p>\n

-Khu tr\u00ean tr\u00e1i:Thu\u1ef3 gan tr\u00e1i, L\u00e1ch, Th\u00e2n v\u00e0 \u0111u\u00f4i tu\u1ef5,Tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn tr\u00e1i, Ph\u1ea7n tr\u00ean th\u1eadn tr\u00e1i, G\u00f3c l\u00e1ch c\u1ee7a \u0111\u1ea1i tr\u00e0ng, m\u1ed9t \u0111o\u1ea1n c\u1ee7a \u0111\u1ea1i tr\u00e0ng ngang v\u00e0 xu\u1ed1ng<\/p>\n

-Khu d\u01b0\u1edbi ph\u1ea3i: C\u1ef1c d\u01b0\u1edbi th\u1eadn ph\u1ea3i, manh tr\u00e0ng v\u00e0 ru\u1ed9t th\u1eeba, m\u1ed9t \u0111o\u1ea1n \u0111\u1ea1i tr\u00e0ng l\u00ean, b\u00e0ng quang, t\u1eed cung, bu\u1ed3ng tr\u1ee9ng v\u00e0 v\u00f2i tr\u1ee9ng ph\u1ea3i, \u1ed1ng d\u1eabn tinh ph\u1ea3i \u1edf nam ,ni\u1ec7u qu\u1ea3n ph\u1ea3i<\/p>\n

-Khu d\u01b0\u1edbi tr\u00e1i: C\u1ef1c d\u01b0\u1edbi th\u1eadn tr\u00e1i, \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng, m\u1ed9t \u0111o\u1ea1n \u0111\u1ea1i tr\u00e0ng xu\u1ed1ng, b\u00e0ng quang, t\u1eed cung, bu\u1ed3ng tr\u1ee9ng v\u00e0 v\u00f2i tr\u1ee9ng tr\u00e1i, \u1ed1ng d\u1eabn tinh tr\u00e1i, ni\u1ec7u qu\u1ea3n tr\u00e1i<\/p>\n

Ru\u1ed9t non \u1edf c\u1ea3 4 khu<\/p>\n

B. C\u00e1ch chia th\u00e0nh 9 v\u00f9ng:<\/p>\n

K\u1ebb 4 \u0111\u01b0\u1eddng: 2 \u0111\u01b0\u1eddng d\u1ecdc v\u00e0 2 \u0111\u01b0\u1eddng ngang<\/p>\n

Hai \u0111\u01b0\u1eddng d\u1ecdc g\u1ed3m:m\u1ed9t \u0111\u01b0\u1eddng tr\u00f9ng v\u1edbi b\u1edd ngo\u00e0i c\u01a1 th\u1eb3ng b\u1ee5ng ph\u1ea3i, m\u1ed9t \u0111\u01b0\u1eddng tr\u00f9ng v\u1edbi b\u1edd ngo\u00e0i c\u01a1 th\u1eb3ng b\u1ee5ng tr\u00e1i. Hai \u0111\u01b0\u1eddng ngang g\u1ed3m: m\u1ed9t \u0111\u01b0\u1eddng \u0111i qua b\u1edd d\u01b0\u1edbi m\u1ea1n s\u01b0\u1eddn ph\u1ea3i, v\u00e0 m\u1ea1n s\u01b0\u1eddn tr\u00e1i, m\u1ed9t \u0111\u01b0\u1eddng \u0111i gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean ph\u1ea3i v\u00e0 tr\u00e1i. B\u1ed1n \u0111\u01b0\u1eddng n\u00e0y chia th\u00e0nh b\u1ee5ng tr\u01b0\u1edbc ra l\u00e0m 9 khu. M\u1ed7i khu c\u00f3 nh\u1eefng c\u01a1 quan t\u01b0\u01a1ng \u1ee9ng nh\u01b0 sau;<\/p>\n

-H\u1ea1 s\u01b0\u1eddn ph\u1ea3i:Thu\u1ef3 gan ph\u1ea3i, t\u00fai m\u1eadt, m\u1ed9t ph\u1ea7n t\u00e1 tr\u00e0ng, g\u00f3c gan \u0111\u1ea1i tr\u00e0ng, c\u1ef1c tr\u00ean th\u1eadn ph\u1ea3i, tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn ph\u1ea3i,<\/p>\n

-Th\u01b0\u1ee3ng v\u1ecb: Thu\u1ef3 gan tr\u00e1i ,m\u00f4n v\u1ecb v\u00e0 m\u1ed9t ph\u1ea7n hang v\u1ecb ,t\u00e1 tr\u00e0ng,tu\u1ef5 t\u1ea1ng,\u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng<\/p>\n

-H\u1ea1 s\u01b0\u1eddn tr\u00e1i: D\u1ea1 d\u00e0y, L\u00e1ch, \u0110u\u00f4i tu\u1ef5, G\u00f3c l\u00e1ch c\u1ee7a \u0111\u1ea1i tr\u00e0ng, c\u1ef1c tr\u00ean th\u1eadn tr\u00e1i, tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn tr\u00e1i<\/p>\n

-H\u00f4ng ph\u1ea3i: \u0110\u1ea1i tr\u00e0ng l\u00ean, n\u1eeda d\u01b0\u1edbi th\u1eadn ph\u1ea3i, m\u1ed9t ph\u1ea7n t\u00e1 tr\u00e0ng, h\u1ed3ng tr\u00e0ng<\/p>\n

-R\u1ed1n: M\u1ea1c n\u1ed1i l\u1edbn, \u0111\u1ea1i tr\u00e0ng ngang, m\u1ea1c treo ru\u1ed9t, ph\u1ea7n th\u1ea5p t\u00e1 tr\u00e0ng, h\u1ed3ng tr\u00e0ng, h\u1ed3i tr\u00e0ng, \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng<\/p>\n

-H\u00f4ng tr\u00e1i: \u0110\u1ea1i tr\u00e0ng xu\u1ed1ng, n\u1eeda d\u01b0\u1edbi th\u1eadn tr\u00e1u, h\u1ed7ng tr\u00e0ng<\/p>\n

-H\u1ed1 ch\u1eadu ph\u1ea3i: Manh tr\u00e0ng, ru\u1ed9t th\u1eeba, h\u1ed3i tr\u00e0ng, ni\u1ec7u qu\u1ea3n ph\u1ea3i, \u1ed1ng d\u1eabn tinh, bu\u1ed3ng tr\u1ee9ng<\/p>\n

-H\u1ed1 ch\u1eadu tr\u00e1i: \u0110\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng, ni\u1ec7u qu\u1ea3n tr\u00e1i, \u1ed1ng d\u1eabn tinhtr\u00e1i, bu\u1ed3ng tr\u1ee9ng tr\u00e1i<\/p>\n

-H\u1ea1 v\u1ecb-H\u1ed7ng tr\u00e0ng, B\u00e0ng quang, T\u1eed cung c\u00f3 thai<\/p>\n

* C\u00e1c \u0111i\u1ec3m \u0111au \u1edf th\u00e0nh b\u1ee5ng:<\/p>\n

-C\u00e1c \u0111i\u1ec3m \u0111au c\u1ee7a Gan, M\u1eadt, Tu\u1ef5<\/p>\n

+\u0110i\u1ec3m t\u00fai m\u1eadt: l\u00e0 giao \u0111i\u1ec3m c\u1ee7a b\u1edd ngo\u00e0i c\u01a1 th\u1eb3ng b\u1ee5ng v\u00e0 b\u1edd d\u01b0\u1edbi m\u1ea1n s\u1eebon ph\u1ea3i, \u0111i\u1ec3m n\u00e0y \u0111au trong vi\u00eam t\u00fai m\u1eadt m\u00e3n t\u00ednh.Trong vi\u00eam t\u00fai m\u1eadt c\u1ea5p t\u00ednh \u0111au kh\u00f4ng c\u00f2n khu tr\u00fa \u1edf \u0111i\u1ec3m t\u00fai m\u1eadt m\u00e0 lan to\u1ea3 c\u1ea3 m\u1ed9t v\u00f9ng<\/p>\n

+\u0110i\u1ec3m m\u0169i \u1ee9c: \u1edf ngay d\u01b0\u1edbi m\u0169i ki\u1ebfm c\u1ee7a x\u01b0\u01a1ng \u1ee9c. \u0110i\u1ec3m n\u00e0y \u0111au khi c\u00f3 b\u1ec7nh l\u00fd \u1edf \u1ed1ng gan tr\u00e1i nh\u01b0 s\u1ecfi, \u0111\u1eb7c bi\u1ec7t l\u00e0 giun chui \u1ed1ng m\u1eadt.<\/p>\n

+Tam gi\u00e1c Chauffard-rivet: h\u1ee3p b\u1edfi \u0111\u01b0\u1eddng r\u1ed1n m\u0169i, \u0111\u01b0\u1eddng ph\u00e2n gi\u00e1c c\u1ee7a g\u00f3c vu\u00f4ng khu tr\u00ean ph\u1ea3i v\u00e0 b\u1edd s\u1eebon ph\u1ea3i<\/p>\n

B\u1ec7nh c\u1ee7a \u0111\u1ea7u tu\u1ef5 v\u00e0 b\u1ec7nh c\u1ee7a \u1ed1ng m\u1eadt ch\u1ee7 \u0111au \u1edf \u0111\u1ec9nh c\u1ee7a tam gi\u00e1c n\u00e0y.<\/p>\n

+\u0110i\u1ec3m Mayo-Robson: l\u00e0 giao \u0111i\u1ec3m c\u1ee7a x\u01b0\u01a1ng s\u01b0\u1eddn th\u1ee912 tr\u00e1i v\u00e0 b\u1edd ngo\u00e0i kh\u1ed1i c\u01a1 l\u01b0ng tr\u00e1i, \u0111i\u1ec3m n\u00e0y \u0111au trong vi\u00eam tu\u1ef5 c\u1ea5p<\/p>\n

-C\u00e1c \u0111i\u1ec3m \u0111au c\u1ee7a d\u1ea1 d\u00e0y v\u00e0 t\u00e1 tr\u00e0ng:<\/p>\n

+\u0110i\u1ec3m th\u01b0\u1ee3ng v\u1ecb: l\u00e0 \u0111i\u1ec3m gi\u1eefa \u0111o\u1ea1n th\u1eb3ng n\u1ed1i m\u0169i \u1ee9c v\u00e0 r\u1ed1n. \u0110i\u1ec3m n\u00e0y \u0111au trong b\u1ec7nh lo\u00e9t d\u1ea1 d\u00e0y<\/p>\n

+\u0110i\u1ec3m t\u00e1 tr\u00e0ng: l\u00e0 \u0111i\u1ec3m gi\u1eefa c\u1ee7a \u0111\u01b0\u1eddng n\u1ed1i r\u1ed1n v\u1edbi \u0111i\u1ec3m th\u1ea5p nh\u1ea5t c\u1ee7a b\u1edd s\u1eeb\u01a1n ph\u1ea3i. \u0110i\u1ec3m n\u00e0y \u0111au khi lo\u00e9t t\u00e1 tr\u00e0ng. Th\u1ef1c t\u1ebf \u0111i\u1ec3m n\u00e0y \u00edt c\u00f3 gi\u00e1 tr\u1ecb<\/p>\n

-C\u00e1c \u0111i\u1ec3m \u0111au c\u1ee7a ru\u1ed9t th\u1eeba:<\/p>\n

+\u0110i\u1ec3m Macburey:l\u00e0 \u0111i\u1ec3m n\u1ed1i 1\/3 ngo\u00e0i v\u00e0 1\/3 gi\u1eefa c\u1ee7a \u0111o\u1ea1n th\u1eb3ng n\u1ed1i gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean ph\u1ea3i v\u1edbi r\u1ed1n.<\/p>\n

+\u0110i\u1ec3m Lanz: l\u00e0 \u0111i\u1ec3m n\u1ed1i 1\/3 ph\u1ea3i v\u00e0 1\/3 gi\u1eefa c\u1ee7a \u0111\u01b0\u1eddng li\u00ean gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean<\/p>\n

+\u0110i\u1ec3m Clado: l\u00e0 \u0111i\u1ec3m n\u1ed1i gi\u1eefa b\u1edd ngo\u00e0i c\u01a1 th\u1eb3ng b\u1ee5ng v\u00e0 \u0111\u01b0\u1eddng li\u00ean gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean<\/p>\n

C\u00e1c \u0111i\u1ec3m n\u00e0y \u0111au trong vi\u00eam ru\u1ed9t th\u1eeba, b\u1ec7nh vi\u00eam ru\u1ed9t th\u1eeba c\u00f3 nhi\u1ec1u \u0111i\u1ec3m \u0111au v\u00ec manh tr\u00e0ng c\u00f3 th\u1ec3 n\u1eb1m cao hay th\u1ea5p v\u00e0 ru\u1ed9t th\u1eeba c\u00f3 th\u1ec3 d\u00e0i hay th\u1ea5p v\u00e0 n\u1eb1m \u1edf nhi\u1ec1u t\u01b0 th\u1ebf kh\u00e1c nhau<\/p>\n

-C\u00e1c \u0111i\u1ec3m \u0111au c\u1ee7a th\u1eadn:<\/p>\n

+\u0110i\u1ec3m s\u1eebon-c\u1ed9t s\u1ed1ng: l\u00e0 giao \u0111i\u1ec3m c\u1ee7a x\u01b0\u01a1ng s\u01b0\u1eddn 12 v\u00e0 b\u1edd c\u1ed9t s\u1ed1ng ph\u1ea3i hay tr\u00e1i<\/p>\n

+\u0110i\u1ec3m s\u01b0\u1eddn-c\u01a1: l\u00e0 giao \u0111i\u1ec3m c\u1ee7a x\u01b0\u01a1ng s\u01b0\u1eddn 12 v\u00e0 b\u1edd kh\u1ed1i c\u01a1 th\u1eaft l\u01b0ng ph\u1ea3i hay tr\u00e1i<\/p>\n

-C\u00e1c \u0111i\u1ec3m \u0111au ni\u1ec7u qu\u1ea3n:<\/p>\n

+\u0110i\u1ec3m ni\u1ec7u qu\u1ea3n tr\u00ean: n\u1eb1m \u1edf c\u1ea1nh r\u1ed1n<\/p>\n

+\u0110i\u1ec3m ni\u1ec7u qu\u1ea3n gi\u1eefa: l\u00e0 giao \u0111i\u1ec3m 1\/3 ngo\u00e0i v\u00e0 1\/3 gi\u1eefa c\u1ee7a \u0111\u1eebong li\u00ean gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean<\/p>\n

+\u0110i\u1ec3m ni\u1ec7u qu\u1ea3n d\u01b0\u1edbi: n\u1eb1m hai tr\u00ean b\u00e0ng quang.T\u00ecm \u0111i\u1ec3m \u0111au n\u00e0y b\u1eb1ng tr\u1ef1c tr\u00e0ng v\u00e0 \u00e2 m \u0111 \u1ea1 o<\/p>\n

+\u0110i\u1ec3m bu\u1ed3ng tr\u1ee9ng:L\u00e0 \u0111i\u1ec3m gi\u1eefa c\u1ee7a \u0111\u01b0\u1eddng n\u1ed1i gai ch\u1eadu tr\u01b0\u1edbc tr\u00ean v\u1edbi b\u1edd tr\u00ean x\u01b0\u01a1ng mu<\/p>\n

C\u00e2u 40: Tr\u00ecnh b\u00e0y c\u00e1c tri\u1ec7u ch\u1ee9ng thu \u0111\u01b0\u1ee3c khi nh\u00ecn trong qu\u00e1 tr\u00ecnh kh\u00e1m b\u1ee5ng ngo\u1ea1i khoa?<\/p>\n

B\u00ecnh th\u01b0\u1eddng th\u00e0nh b\u1ee5ng bao gi\u1edd c\u0169ng di \u0111\u1ed9ng nh\u1ecbp nh\u00e0ng theo \u0111\u1ed9ng t\u00e1c th\u1edf. Trong nh\u1eefng tr\u01b0\u00f2ng h\u1ee3p b\u1ec7nh l\u00fd, c\u00f3 th\u1ec3 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng sau:<\/p>\n

1. B\u1ee5ng kh\u00f4ng th\u1edf:Th\u00e0nh b\u1ee5ng kh\u00f4ng di \u0111\u1ed9ng theo \u0111\u1ed9ng t\u00e1c th\u1edf.<\/p>\n

\u1ede nh\u1eefng ng\u01b0\u1eddi kho\u1ebb m\u1ea1nh, l\u1ef1c l\u01b0\u1ee1ng khi b\u1ee5ng kh\u00f4ng th\u1edf c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c th\u1edb c\u01a1 th\u00e0nh b\u1ee5ng n\u1ed5i l\u00ean, h\u1eb1n t\u1eebng m\u00fai \u1edf hai b\u00ean l\u00e0 c\u00e1c th\u1edb c\u01a1 ch\u00e9o ngo\u00e0i n\u1ed5i r\u00f5, di ch\u1ebfch t\u1eeb tr\u00ean xu\u1ed1ng d\u01b0\u1edbi, t\u1eeb trong ra ngo\u00e0i.<\/p>\n

Tri\u1ec7u ch\u1ee9ng n\u00e0y bi\u1ec3u hi\u1ec7n m\u1ed9t t\u00ecnh tr\u1ea1ng vi\u00eam ph\u00fac m\u1ea1c. Khi b\u1ecb vi\u00eam, ph\u00fac m\u1ea1c b\u1ecb k\u00edch th\u00edch t\u0103ng c\u1ea3m gi\u00e1c \u0111au. M\u1ed7i khi th\u00e0nh b\u1ee5ng di chuy\u1ec3n l\u00e0m b\u1ec7nh nh\u00e2n r\u1ea5t \u0111au. B\u1ee5ng kh\u00f4ng th\u1edf r\u00f5 nh\u1ea5t l\u00e0 trong th\u1ee7nng d\u1ea1 d\u00e0y.<\/p>\n

2. B\u1ee5ng tr\u01b0\u1edbng: B\u1ee5ng tr\u01b0\u1edbng to\u00e0n th\u1ec3 v\u00e0 tr\u01b0\u1edbng trongt\u1eafc ru\u1ed9t c\u01a1 n\u0103ng hay t\u1eafc ru\u1ed9c c\u01a1 h\u1ecdc \u1edf th\u1ea5p. B\u1ee5ng ch\u1ec9 tr\u01b0\u1edbng \u1edf tr\u00ean, b\u1ee5ng d\u01b0\u1edbi l\u1ea1i l\u00e9p g\u1eb7p trong h\u1eb9p m\u00f4n v\u1ecb (h\u00ecnh l\u00f5m l\u00f2ng thuy\u1ec1n).B\u1ee5ng tr\u01b0\u1edbng l\u1ec7ch m\u1ed9t b\u00ean th\u1ea5y trong xo\u1eafn \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng<\/p>\n

3. B\u1ee5ng to: do c\u00f3 d\u1ecbch trong \u1ed5 b\u1ee5ng, th\u01b0\u1eddng g\u1eb7p trong b\u1ec7nh x\u01a1 gan. Khi trong b\u1ee5ng c\u00f3 nhi\u1ec1u d\u1ecbch, r\u1ed1n th\u01b0\u1eddng l\u1ed3i. B\u1ee5ng to c\u0169ng c\u00f3 th\u1ec3 do b\u00e9o m\u1eadp, th\u00e0nh b\u1ee5nng d\u00e0y do c\u00f3 nhi\u1ec1u m\u1ee1 v\u00e0 ph\u1ee5 n\u1eef c\u00f3 thai<\/p>\n

4. Quai ru\u1ed9t n\u1ed5i, d\u1ea5u hi\u1ec7u r\u1eafn b\u00f2, d\u1ea5u hi\u1ec7u von wahl:<\/p>\n

+Quai ru\u1ed9t n\u1ed5i l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u1eafc ru\u1ed9t c\u01a1 n\u0103ng d\u1eabn \u0111\u1ebfn t\u1eafc ru\u1ed9t c\u01a1 h\u1ecdc.Khi b\u1ee5ng tr\u01b0\u1edbng, nh\u00ecn l\u00ean th\u00e0nh b\u1ee5ng th\u1ea5y nh\u1eefng quai ru\u1ed9t n\u1ed5i r\u00f5, n\u1eb1m im<\/p>\n

C\u00e1c quai ru\u1ed9t c\u00f3 th\u1ec3 di truy\u1ec1n t\u1eebng l\u00fac t\u1eeb n\u01a1i n\u00e0y sang n\u01a1i kh\u00e1c, gi\u1ed1ng nh\u01b0 con r\u1eafn \u0111ang b\u00f2, c\u0169ng c\u00f3 khi kh\u00f4ng th\u1ea5y di chuy\u1ec3n nh\u01b0ng l\u00fac n\u1ed5i g\u1ed3 l\u00ean, l\u00fac m\u1ea5t \u0111i. Khi kh\u00e1m b\u1ee5ng nghi ng\u1edd c\u00f3 t\u1eafc ru\u1ed9t n\u1ebfu kh\u00f4ng th\u1ea5y d\u1ea5u hi\u1ec7u r\u1eafn b\u00f2 ph\u1ea3i \u0111\u1ee3i nhi\u1ec1u ph\u00fat hay ph\u1ea3i b\u00fang nh\u1eb9 tr\u00ean th\u00e0nh b\u1ee5ng \u0111\u1ec3 k\u00edch th\u00edch nhu \u0111\u1ed9ng ru\u1ed9t. Mu\u1ed1n nh\u1eadn \u0111\u1ecbnh tri\u1ec7u ch\u1ee9ng d\u1ec5 d\u00e0ng th\u00ec c\u1ea7n c\u00f3 \u0111\u1ee7 \u00e1nh s\u00e1ng v\u00e0 th\u1ea7y thu\u1ed1c nh\u00ecn ti\u1ebfp tuy\u1ebfn v\u1edbi th\u00e0nh b\u1ee5ng.<\/p>\n

+D\u1ea5u hi\u1ec7u r\u1eafn b\u00f2: do quai ru\u1ed9t co b\u00f3p m\u1ea1nh h\u01a1n \u0111\u1ec3 t\u1ed1ng T\u0102 qua ch\u1ed7 t\u1eafc nh\u01b0ng kh\u00f4ng hi\u1ec7u qu\u1ea3.<\/p>\n

D\u1ea5u hi\u1ec7u r\u1eafn b\u00f2 \u0111\u1eb7c hi\u1ec7u trong t\u1eafc ru\u1ed9t c\u01a1 h\u1ecdc. C\u00f3 khi ch\u1ec9 th\u1ea5y 1 quai ru\u1ed9t n\u1ed5i l\u00ean, n\u1eb1m im, \u1ea5n r\u1ea5t \u0111au: d\u1ea5u hi\u1ec7u Von Wahl, \u0111\u00f3 l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a 1 quai ru\u1ed9t b\u1ecb t\u1eafc \u1edf hai \u0111\u1ea7u<\/p>\n

5. Nh\u1eefng u b\u1ea5t th\u01b0\u1eddng:<\/p>\n

U m\u1ec1m xu\u1ea5t hi\u1ec7n \u1edf v\u00f9ng r\u1ed1n, v\u00f9ng b\u1eb9n b\u00ecu, v\u00f9ng \u0111\u00f9i, khi \u0111\u00e8 v\u00e0o kh\u00f4ng m\u1ea5t \u0111i v\u00e0 b\u1ec7nh nh\u00e2n r\u1ea5t \u0111au l\u00e0 tho\u00e1t v\u1ecb gh\u1eb9t<\/p>\n

U \u1edf nh\u1eefng v\u00f9ng kh\u00e1c l\u00e0 do c\u00e1c t\u1ea1ng to l\u00ean nh\u01b0 gan to, l\u00e1ch to, c\u00e1c t\u1ea1ng c\u00f3 u nh\u01b0 ung th\u01b0 gan, u x\u01a1 t\u1eed cung, c\u00e1c t\u1ea1ng c\u00f3 nag nh\u01b0 nang tu\u1ef5, nang bu\u1ed3n tr\u1ee9ng\u2026<\/p>\n

M\u1ed9t kh\u1ed1i l\u00fac c\u00f3 l\u00fac kh\u00f4ng th\u01b0\u1eddng l\u00e0 kh\u1ed1i l\u1ed3ng ru\u1ed9t<\/p>\n

6. Nh\u1eefng d\u1ea5u hi\u1ec7u kh\u00e1c<\/p>\n

Do ph\u00f9 n\u1ec1 v\u00e0 t\u1ea5y \u0111\u1ecf: l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a m\u1ed9t \u1ed5 m\u1ee7 n\u1eb1m trong xoang b\u1ee5ng nh\u01b0 apces gan, apces ru\u1ed9t th\u1eeba, apces d\u01b0\u1edbi ho\u00e0nh \u2026.\u0111\u00e3 d\u00ednh v\u00e0o th\u00e0nh b\u1ee5ng, c\u00f3 th\u1ec3 v\u1ee1 v\u00e0o th\u00e0nh b\u1ee5ng v\u00e0 tho\u00e1t m\u1ee7 ra ngo\u00e0i.<\/p>\n

Nh\u1eefng v\u1ebft b\u1ea7m m\u00e1u \u1edf r\u1ed1n, \u1edf h\u00f4ng g\u1eb7p trong vi\u00eam tu\u1ef5 c\u1ea5p th\u1ec3 xu\u1ea5t huy\u1ebft.Nhi\u1ec1u t\u0129nh m\u1ea1ch n\u1ed5i \u1edf v\u00f9ng r\u1ed1n trong h\u1ed9i ch\u1ee9ng t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda.<\/p>\n

C\u00f3 v\u1ebft s\u1eb9o m\u1ed5 c\u0169; c\u1ea7n bi\u1ebft s\u1ed1 l\u01b0\u1ee3ng, v\u1ecb tr\u00ed, th\u1eddi gian, t\u00ednh ch\u1ea5t.<\/p>\n

V\u1ebft r\u1ea1n \u1edf da th\u00e0nh b\u1ee5ng m\u00e0u n\u00e2n hay m\u00e0u tr\u1eafng \u1edf ph\u1ee5 n\u1eef mang thai hay sau sinh l\u00e0 tr\u1ea1ng th\u00e1i sinh l\u00fd b\u00ecnh th\u01b0\u1eddng<\/p>\n

C\u00e2u 37: Tr\u00ecnh b\u00e0y \u0111\u1ed9ng t\u00e1c “s\u1edd” trong th\u0103m kh\u00e1m b\u1ee5ng ngo\u1ea1i khoa?<\/p>\n

S\u1edd n\u1eafn l\u00e0 kh\u00e2u quan tr\u1ecdng nh\u1ea5t trong kh\u00e1m b\u1ee5ng. Nh\u1eefng d\u1ea5u hi\u1ec7u c\u1ee7a s\u1edd n\u1eafn th\u01b0\u1eddng l\u00e0 nh\u1eefng d\u1ea5u hi\u1ec7u quy\u1ebft \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n<\/p>\n

Tr\u01b0\u1edbc khi s\u1edd n\u1eafn ph\u1ea3i b\u00e1o cho b\u1ec7nh nh\u00e2n bi\u1ebft. N\u1eafn nh\u1eb9 nh\u00e0ng, b\u1eb1ng m\u1eb7t gan tay c\u1ee7a c\u00e1c \u0111\u1ea7u ng\u00f3n 2-3-4, c\u00f3 khi c\u1ea3 ng\u00f3n 5. Khi c\u1ea7n c\u00f3 th\u1ec3 ch\u1ec9 d\u00f9ng \u0111\u1ea7u ng\u00f3n 2 nh\u01b0 khi t\u00ecm ph\u1ea3n \u1ee9ng d\u1ed9i. H\u1ebft s\u1ee9c tr\u00e1nh \u0111\u1ed9ng t\u00e1c th\u00f4 b\u1ea1o, s\u1edd n\u1eafn \u0111\u1ed9t ng\u1ed9t. Nhi\u1ec1u khi ph\u1ea3i d\u00f9ng c\u1ea3 2 b\u00e0n tay nh\u01b0 khi t\u00ecm d\u1ea5u hi\u1ec7u ch\u1ea1m th\u1eadn, b\u1eadp b\u1ec1nh th\u1eadn m\u1ed9t b\u00e0n tay \u0111\u1eb7t tr\u00ean th\u00e0nh b\u1ee5ng, m\u1ed9t b\u00e0n tay \u0111\u1eb7t \u1edf l\u01b0ng.<\/p>\n

1. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a th\u00e0nh b\u1ee5ng v\u00e0 c\u1ee7a ph\u00fac m\u1ea1c<\/p>\n

– Co c\u1ee9ng th\u00e0nh b\u1ee5ng: khi nh\u00ecn \u0111\u00e3 th\u1ea5y b\u1ee5ng kh\u00f4ng th\u1edf, c\u00e1c c\u01a1 n\u1ed5i h\u1eb1n.khi s\u1edd nh\u1eb9 v\u00e0o th\u00e0nh b\u1ee5ng c\u00f3 c\u1ea3m gi\u00e1c nh\u01b0 s\u1edd v\u00e0o m\u1ea3nh gi\u1ea5y n\u00e9n, 1 c\u00e1i mo cau hay 1 m\u1ea3nh g\u1ed7. Co c\u1ee9ng l\u00e0 do c\u00e1c c\u01a1 co l\u1ea1i l\u00e0m cho th\u00e0nh b\u1ee5ng c\u1ee9ng l\u00ean. Co c\u1ee9ng c\u00f3 c\u00e1c t\u00ednh ch\u1ea5t: c\u1ea3 b\u1ec7nh nh\u00e2n v\u00e0 th\u1ea7y thu\u1ed1c \u0111\u1ec1u kh\u00f4ng th\u1ebb l\u00e0m cho th\u00e0nh b\u1ee5ng m\u1ec1m \u0111\u01b0\u1ee3c v\u00e0 khi \u1ea5n \u1ec7nh nh\u00e2n r\u1ea5t \u0111au. Co c\u1ee9ng c\u00f3 th\u1ec3 \u1edf to\u00e0n th\u1ec3 b\u1ee5ng, c\u00f3 th\u1ec3 ch\u1ec9 \u1edf 1 v\u00f9ng. M\u1ee9c \u0111\u1ed9 co c\u1ee9ng kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o tu\u1ed5i t\u00e1c, th\u00e2n h\u00ecnh, t\u00ednh ch\u1ea5t b\u1ec7nh… co c\u1ee9ng l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a vi\u00eam ph\u00fac m\u1ea1c.<\/p>\n

– Ph\u1ea3n \u1ee9ng th\u00e0nh b\u1ee5ng: khi s\u1edd n\u1eafn r\u1ea5t nh\u1eb9 nh\u00e0ng, th\u00e0nh b\u1ee5ng v\u1eabn m\u1ec1m. Khi \u1ea5n m\u1ea1nh d\u1ea7n, t\u1edbi 1 l\u00fac n\u00e0o \u0111\u00f3, th\u00e0nh b\u1ee5ng c\u1ee9ng l\u1ea1i ng\u0103n c\u1ea3n b\u00e0n tay kh\u00e1m kh\u00f4ng cho \u1ea5n s\u00e2u h\u01a1n v\u00ec \u1ea5n s\u00e2u h\u01a1n s\u1ebd \u0111au h\u01a1n. N\u1ebfu l\u00e0 b\u1ec7nh nhi th\u00ec ch\u00e1u b\u00e9 th\u01b0\u1eddng g\u1ea1t tay ho\u1eb7c t\u00fam l\u1ea5y tay th\u1ea7y thu\u1ed1c. Ph\u1ea3n \u1ee9ng n\u00e0y l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a 1 th\u01b0\u01a1ng t\u1ed5n vi\u00eam nhi\u1ec5m trong \u1ed5 b\u1ee5ng.<\/p>\n

– C\u1ea3m \u1ee9ng ph\u00fac m\u1ea1c: d\u00f9ng c\u00e1c \u0111\u1ea7u ng\u00f3n tay \u1ea5n nh\u1eb9 nh\u00e0ng v\u00e0o th\u00e0nh b\u1ee5ng b\u1ec7nh nh\u00e2n r\u1ea5t \u0111au. \u0110au l\u00e0 do ph\u00fac m\u1ea1c \u0111ang viem b\u1ecb \u0111\u1ee5ng ch\u1ea1m. \u0110\u00e2y c\u0169ng l\u00e0 tri\u1ec7u ch\u1ee9ng quan tr\u1ecdng c\u1ee7a vi\u00eam ph\u00fac m\u1ea1c.<\/p>\n

– Ph\u1ea3n \u1ee9ng d\u1ed9i: \u0111\u1ea7u ng\u00f3n tay tr\u1ecf \u1ea5n r\u1ea5t nh\u1eb9 nh\u00e0ng v\u00e0o th\u00e0nh b\u1ee5ng. M\u1ed7i l\u00fac \u1ea5n m\u1ed9t s\u00e2u h\u01a1n r\u1ed3i bu\u00f4ng tay ra 1 c\u00e1ch \u0111\u1ed9t ng\u1ed9t, b\u1ec7nh nh\u00e2n \u0111au ch\u00f3i n\u01a1i \u1ea5n tay. T\u00ecm ph\u1ea3n \u1ee9ng d\u1ed9i khi d\u1ea5u hi\u1ec7u vi\u00eam ph\u00fac m\u1ea1c bi\u1ec3u hi\u1ec7n kh\u00f4ng r\u00f5 r\u1ec7t.<\/p>\n

2. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a kh\u1ed1i u b\u1ee5ng<\/p>\n

– V\u1ecb tr\u00ed: l\u00e0 c\u0103n c\u1ee9 \u0111\u1ea7u ti\u00ean trong ch\u1ea9n \u0111o\u00e1n b\u1ec7nh. U \u1edf m\u1ea1ng s\u01b0\u1eddn ph\u1ea3i ngh\u0129 t\u1edbi t\u00fai m\u1eadt to, u ung th\u01b0 gan; \u1edf m\u1ea1ng s\u01b0\u1eddn tr\u00e1i ngh\u0129 t\u1edbi l\u00e1ch to, l\u00e1ch c\u00f3 b\u1edd r\u0103ng c\u01b0a. U \u1edf tr\u00ean x\u01b0\u01a1ng mu ngh\u0129 t\u1edbi b\u00e0ng quang c\u0103ng do b\u00ed ti\u1ec3u, \u1edf ph\u1ee5 n\u1eef ngh\u0129 t\u1edbi t\u1eed cung to do c\u00f3 thai hay do u x\u01a1. U \u1edf h\u1ed1 ch\u1eadu ph\u1ea3i ngh\u0129 t\u1edbi u manh tr\u00e0ng, u \u1edf h\u1ed1 ch\u1eadu tr\u00e1i ngh\u0129 t\u1edbi u \u0111\u1ea1i tr\u00e0ng ch\u1eadu h\u00f4ng.<\/p>\n

– K\u00edch th\u01b0\u1edbc: u to hay nh\u1ecf, c\u0103n c\u1ee9 v\u00e0o \u0111\u01b0\u1eddng k\u00ednh d\u1ecdc v\u00e0 \u0111\u01b0\u1eddng k\u00edn ngang c\u1ee7a kh\u1ed1i u, t\u00ednh b\u1eb1ng centimet.<\/p>\n

– H\u00ecnh d\u1ea1ng: H\u00ecnh tr\u00f2n, b\u1ea7u d\u1ee5c hay d\u00e0i.<\/p>\n

– M\u1eadt \u0111\u1ed9: c\u1ee9ng, c\u0103ng hay m\u1ec1m. C\u1ee9ng l\u00e0 tr.ch\u1ee9ng c\u1ee7a u \u0111\u1eb7c nh\u01b0 ung th\u01b0 gan u x\u01a1 t\u1eed cung… c\u0103ng, m\u1ec1m l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a c\u00e1c t\u00fai n\u01b0\u1edbc nh\u01b0 t\u00fai m\u1eadt c\u0103ng, b\u00e0ng quang \u0111\u1ea7y n\u01b0\u1edbc, nang t\u1ee5y, nang bu\u1ed3ng tr\u1ee9ng…<\/p>\n

– B\u1ec1 m\u1eb7t: nh\u1eb5n \u0111\u1ec1u, g\u1ed3 gh\u1ec1, c\u00f3 m\u00fai. U ung th\u01b0 gan c\u00f3 l\u1ed5n nh\u1ed5n, abces th\u00ec m\u1eb7t nh\u1eb5n. Khi l\u00e1ch to s\u1edd th\u1ea5y b\u1edd r\u0103ng c\u01b0a.<\/p>\n

– B\u1edd c\u00f3 ranh gi\u1edbi r\u00f5 r\u1ec7t hay kh\u00f4ng.<\/p>\n

– Di \u0111\u1ed9ng hay kh\u00f4ng. Di \u0111\u1ed9ng t\u1ef1 nhi\u00ean theo nh\u1ecbp th\u1edf hay di \u0111\u1ed9ng khi c\u1ea7m tay l\u1eafc.di \u0111\u1ed9ng theo chi\u1ec1u tr\u00ean – d\u01b0\u1edbi, ph\u1ea3i tr\u00e1i, tr\u01b0\u1edbc – sau.<\/p>\n

– \u0110au hay kh\u00f4ng. \u0110au t\u1ef1 nhi\u00ean hay \u0111au khi \u1ea5n. \u0110au nhi\u1ec1u hay \u00edt. \u0110au khi t\u1ed5n th\u01b0\u01a1ng l\u00e0 vi\u00eam, r\u1ea5t dau khi t\u1ed5n th\u01b0\u01a1ng l\u00e0 abces, kh\u00f4ng \u0111au ho\u1eb7c \u0111au \u00edt khi l\u00e0 kh\u1ed1i u.<\/p>\n

– \u0110\u1eadp theo nh\u1ecbp tim l\u00e0 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng hay u m\u1ec1m n\u1eb1m s\u00e1t c\u1ea1nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng.<\/p>\n

– U c\u00f3 th\u01b0\u1eddng xuy\u00ean hay l\u00fac c\u00f3 l\u00fac kh\u00f4ng (u l\u1ed3ng ru\u1ed9t nh\u01b0 l\u1ed3ng h\u1ed3i-manh-\u0111\u1ea1i tr\u00e0ng).<\/p>\n

3. C\u00e1c thao t\u00e1c \u0111\u1ec3 t\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u<\/p>\n

3.1. D\u1ea5u hi\u1ec7u Murphy:<\/p>\n

C\u00e1c \u0111\u1ea7u ng\u00f3n b\u00e0n tay ph\u1ea3i \u0111\u1eb7t tr\u00ean v\u00f9ng d\u01b0\u1edbi b\u1edd s\u01b0\u1eddn ph\u1ea3i. B\u1ec7nh nh\u00e2n h\u00edt s\u00e2u, m\u1ed7i l\u1ea7n th\u1edf th\u1ea7y thu\u1ed1c \u1ea5n tay s\u00e2u th\u00eam, sau 3 \u2013 4 l\u1ea7n th\u1edf \u0111ang h\u00edt v\u00e0o b\u1ec7nh nh\u00e2n ng\u01b0ng th\u1edf \u0111\u1ed9t ng\u1ed9t v\u00ec \u0111au\u00e0 Murphy (+) g\u1eb7p trong : vi\u00eam t\u00fai m\u1eadt th\u1ec3 teo.<\/p>\n

3.2. D\u1ea5u hi\u1ec7u rung gan:<\/p>\n

B\u00e0n tay tr\u00e1i th\u1ea7y thu\u1ed1c \u0111\u1eb7t l\u00ean ng\u1ef1c ph\u1ea3i BN, c\u00e1c ng\u00f3n tay \u0111\u1eb7t tr\u00ean c\u00e1c khoang li\u00ean s\u01b0\u1eddn t\u01b0\u01a1ng \u1ee9ng v\u1ecb tr\u00ed gan, tay ph\u1ea3i ch\u1eb7t nh\u1eb9 l\u00ean tay tr\u00e1i , BN \u0111au \u00e0 Rung gan (+) . G\u1eb7p trong apxe gan.<\/p>\n

3.3. D\u1ea5u hi\u1ec7u Kehr :<\/p>\n

BN n\u1eb1m ng\u1eeda quay th\u1ea5p \u0111\u1ea7u gi\u01b0\u1eddng kho\u1ea3ng 150 th\u1ea5y \u0111au \u1edf vai tr\u00e1i\u00e0D\u1ea5u hi\u1ec7u Kehr (+) \u00e0 c\u00f3 m\u00e1u ,d\u1ecbch trong \u1ed5 b\u1ee5ng<\/p>\n

3.4. D\u1ea5u hi\u1ec7u Bouveret:<\/p>\n

Khi \u0111\u1eb7t tay l\u00ean v\u00f9ng th\u01b0\u1ee3ng v\u1ecb c\u1ee7a BN th\u1ea5y c\u00f3 c\u1ea3m gi\u00e1c cu\u1ed9n d\u01b0\u1edbi tay, do d\u1ea1 d\u00e0y t\u0103ng co b\u00f3p khi c\u00f3 h\u1eb9p m\u00f4n v\u1ecb.<\/p>\n

3.5. D\u1ea5u hi\u1ec7u \u00f3c \u00e1ch:<\/p>\n

Bu\u1ed5i s\u00e1ng khi b\u1ec7nh nh\u00e2n ch\u01b0a \u0103n, tai th\u1ea7y thu\u1ed1c \u00e1p s\u00e1t th\u00e0nh b\u1ee5ng, 2 b\u00e0n tay \u00f4m l\u1ea5y h\u00f4ng b\u1ec7nh nh\u00e2n l\u1eafc m\u1ea1nh, khi m\u00f4n v\u1ecb b\u1ecb h\u1eb9p trong d\u1ea1 d\u00e0y c\u00f3 \u1ee9 d\u1ecbch s\u1ebd nghe ti\u1ebfng \u00f3c \u00e1ch.<\/p>\n

3.6. D\u1ea5u hi\u1ec7u Howship Romberg:<\/p>\n

BN n\u1eb1m ng\u1eeda 2 ch\u00e2n g\u1ea5p, th\u1ea7y thu\u1ed1c \u0111\u1ea9y d\u1ea1ng 2 ch\u00e2n ra. D\u1ea5u hi\u1ec7u Howship Romberg (+) khi b\u1ec7nh nh\u00e2n \u0111au nh\u01b0 x\u00e9 d\u1ecdc theo m\u1eb7t trong do th\u1ea7n kinh b\u1ecbt b\u1ecb ch\u00e8n \u00e9p trong tho\u00e1t v\u1ecb b\u1ecbt.<\/p>\n

3.7. D\u1ea5u hi\u1ec7u ph\u00ecnh th\u00f3p b\u1ee5ng:<\/p>\n

BN th\u00f3p b\u1ee5ng l\u1ea1i r\u1ed3i ph\u00ecnh ra \u0111\u1ed9t ng\u1ed9t, khi \u1ed5 b\u1ee5ng c\u00f3 vi\u00eam b\u1ec7nh nh\u00e2n th\u1ea5y \u0111au, th\u01b0\u1eddng d\u00f9ng trong ch\u1ea9n \u0111o\u00e1n vi\u00eam ru\u1ed9t th\u1eeba.<\/p>\n

3.8. D\u1ea5u hi\u1ec7u Rovsing:<\/p>\n

B\u00e0n tay th\u1ea7y thu\u1ed1c \u0111\u1eb7t \u1edf h\u1ed1 ch\u1eadu ph\u1ea3i \u1ea5n \u0111\u1ea9y th\u00e0nh b\u1ee5ng v\u1ec1 ph\u00eda ph\u1ea3i, n\u1ebfu ru\u1ed9t th\u1eeba vi\u00eam BN \u0111au \u1edf h\u1ed1 ch\u1eadu ph\u1ea3i.<\/p>\n

3.9. D\u1ea5u hi\u1ec7u c\u01a1 th\u0103n:<\/p>\n

BN n\u1eb1m ng\u1eefa kh\u00f4ng d\u00e1m du\u1ed7i ch\u00e2n v\u00ec khi du\u1ed7i c\u01a1 th\u0103n c\u0103ng g\u00e2y \u0111au, khi th\u1ea7y thu\u1ed1c \u0111\u00e8 v\u00e0o g\u1ed1i l\u00e0m du\u1ed7i b\u1ec7nh nh\u00e2n cong l\u01b0ng l\u00ean. D\u1ea5u hi\u1ec7u c\u01a1 th\u0103n (+) khi c\u01a1 th\u0103n vi\u00eam nh\u01b0 ru\u1ed9t th\u1eeba sau manh tr\u00e0ng.<\/p>\n

3.10. Ch\u1ea1m th\u1eadn:<\/p>\n

2 b\u00e0n tay th\u1ea7y thu\u1ed1c \u0111\u1eb7t \u1edf h\u00f4ng l\u01b0ng b\u1ec7nh nh\u00e2n, 1 tay \u1edf tr\u01b0\u1edbc, 1 tay \u1edf sau. Khi tay tr\u01b0\u1edbc \u1ea5n m\u1ea1nh c\u1ea3m gi\u00e1c \u0111\u01b0\u1ee3c 1 v\u1eadt ch\u1ea1m b\u00e0n tay ph\u00eda sau.<\/p>\n

3.11. B\u1eadp b\u1ec1nh th\u1eadn:<\/p>\n

2 b\u00e0n tay th\u1ea7y thu\u1ed1c \u0111\u1eb7t \u1edf h\u00f4ng l\u01b0ng b\u1ec7nh nh\u00e2n, 1 tay \u1edf ph\u00eda tr\u01b0\u1edbc, 1 tay \u1edf ph\u00eda sau. Tay ph\u00eda sau \u0111\u1ea9y ra tr\u01b0\u1edbc v\u00e0 tay ph\u00eda tr\u01b0\u1edbc \u0111\u1ea9y ra ph\u00eda sau , c\u1ea3 2 tay c\u00f3 c\u1ea3m gi\u00e1c nh\u01b0 v\u1eadt g\u00ec ch\u1ea1m v\u00e0o.<\/p>\n

* Ch\u1ea1m th\u1eadn, b\u1eadp b\u1ec1nh th\u1eadn \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh th\u1eadn to, kh\u1ed1i u th\u1eadn hay th\u1eadn sa.<\/p>\n

C\u00e2u 35: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 nguy\u00ean nh\u00e2n g\u00e3y x\u01b0\u01a1ng?<\/p>\n

I. Tri\u1ec7u ch\u1ee9ng<\/p>\n

1. L\u00e2m s\u00e0ng:<\/p>\n

C\u00f3 nhi\u1ec1u d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng khi co g\u00e3y x\u01b0\u01a1ng. C\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng ch\u00ednh \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh 2 nh\u00f3m ch\u00ednh:<\/p>\n

\u00d8 C\u00e1c d\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng<\/p>\n

– Bi\u1ebfn d\u1ea1ng (5 ki\u1ec3u): di l\u1ec7ch do l\u1ee9c ch\u1ea5n th\u01b0\u01a1ng or co k\u00e9o c\u01a1 t\u1ea1o n\u00ean<\/p>\n

– C\u1eed \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng<\/p>\n

– Ti\u1ebfng l\u1ea1o x\u1ea1o<\/p>\n

\u00d8 C\u00e1c d\u1ea5u hi\u1ec7u kh\u00f4ng ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng<\/p>\n

– \u0110au: \u0111au t\u1ef1 nhi\u00ean \u00edt<\/p>\n

– S\u01b0ng, b\u1ea7m t\u00edm<\/p>\n

– M\u1ea5t c\u01a1 n\u0103ng nhi\u1ec1u<\/p>\n

C\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng \u0111\u1ec1u c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u k\u1ec3 tr\u00ean. Song c\u00e1c ch\u1ea5n th\u01b0\u01a1ng kh\u00e1c nh\u01b0 tr\u1eadt kh\u1edbp, bong g\u00e2n…. c\u0169ng c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u \u0111\u00f3, n\u00ean kh\u00f3 kh\u1eb3ng \u0111\u1ecbnh ch\u1eafc ch\u1eafn l\u00e0 g\u00e3y x\u01b0\u01a1ng hay kh\u00f4ng.<\/p>\n

2. C\u00e1c d\u1ea5u hi\u1ec7u h\u00ecnh \u1ea3nh: C\u00f3 th\u1ec3 d\u00f9ng c\u00e1c h\u00ecnh th\u1ee9c sau \u0111\u00e2y x\u00e1c \u0111\u1ecbnh g\u00e3y x\u01b0\u01a1ng<\/p>\n

\u00d8 X quang quy \u01b0\u1edbc th\u00f4ng th\u01b0\u1eddng:<\/p>\n

– T\u1ed1i thi\u1ec3u 2 b\u00ecnh di\u1ec7n (m\u1eb7t v\u00e0 b\u00ean)<\/p>\n

– C\u00e1c t\u01b0 th\u1ebf kh\u00e1c n\u1ebfu c\u1ea7n<\/p>\n

– Ch\u1ee5p l\u1ea5y \u0111\u1ee7 2 kh\u1edbp c\u1ee7a 1 th\u00e2n x\u01b0\u01a1ng d\u00e0i<\/p>\n

\u00d8 Ch\u1ee5p X quang c\u1eaft l\u1edbp c\u1ed5 \u0111i\u1ec3n ho\u1eb7c c\u1eaft l\u1edbp \u0111i\u1ec7n to\u00e1n (CT scan) \u0111\u1ed1i v\u1edbi c\u00e1c g\u00e3y x\u01b0\u01a1ng ph\u1ee9c t\u1ea1p<\/p>\n

\u00d8 Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI): \u00edt d\u00f9ng<\/p>\n

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

1. G\u00e3y x\u01b0\u01a1ng ch\u1ea5n th\u01b0\u01a1ng (\u0111a s\u1ed1)<\/p>\n

Nguy\u00ean nh\u00e2n l\u00e0 l\u1ef1c b\u00ean ngo\u00e0i t\u00e1c \u0111\u1ed9ng l\u00ean xuownglanhf m\u1ea1nh b\u00ecnh th\u01b0\u1eddng. L\u1ef1c ch\u1ea5n th\u01b0\u01a1ng g\u1ecdi l\u00e0 t\u00e1c nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 t\u1ea1o ra:<\/p>\n

\u00d8 G\u00e3y x\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp n\u1ebfu n\u01a1i g\u00e3y \u1edf ch\u00ednh n\u01a1i \u0111i\u1ec3m \u0111\u1eb7t c\u1ee7a t\u00e1c nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng<\/p>\n

\u00d8 G\u00e3y x\u01b0\u01a1ng gi\u00e1n ti\u1ebfp n\u1ebfu n\u01a1i g\u00e3y x\u01b0\u01a1ng \u1edf xa \u0111i\u1ec3m \u0111\u1eb7t c\u1ea3u t\u00e1c nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng<\/p>\n

T\u00e1c nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng b\u00ean ngo\u00e0i t\u00e1c \u0111\u1ed9ng l\u00e0m cho c\u01a1 c\u0103ng th\u1eb3ng ra v\u00e0 k\u00e9o m\u1ea1nh l\u00e0m m\u1ebb x\u01b0\u01a1ng n\u01a1i b\u00e1m c\u1ee7a t\u1eadn g\u00e2n. \u0110\u00f3 l\u00e0 tr\u01b0\u1eddng h\u1ee3p m\u1ebb x\u01b0\u01a1ng m\u1ecfm khu\u1ef7u n\u01a1i b\u00e1m t\u1eadn c\u1ee7a c\u01a1 tam \u0111\u1ea7u c\u00e1nh tay<\/p>\n

T\u00e1c nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng b\u00ean ngo\u00e0i l\u00e0m c\u0103ng qu\u00e1 m\u1ee9c d\u00e2y ch\u1eb1ng v\u00e0 ch\u00ednh d\u00e2y ch\u1eb1ng c\u0103ng th\u1eb3ng \u0111\u00e3 gi\u1eb1ng m\u1ebb x\u01b0\u01a1ng \u1edf n\u01a1i b\u00e1m t\u1eadn c\u1ee7a d\u00e2y ch\u1eb1ng. \u0110\u00f3 l\u00e0 tr\u01b0\u1eddng h\u1ee3p m\u1ebb x\u01b0\u01a1ng n\u01a1i b\u00e1m t\u1eadn c\u1ee7a d\u00e2y ch\u1eb1ng b\u00ean ch\u00e0y kh\u1edbp g\u1ed1i.<\/p>\n

2. G\u00e3y b\u1ec7nh l\u00fd: (g\u00e3y t\u1ef1 nhi\u00ean)<\/p>\n

N\u1ebfu 1 x\u01b0\u01a1ng b\u1ecb m\u1eafc b\u1ec7nh t\u1eeb tr\u01b0\u1edbc: vi\u00eam x\u01b0\u01a1ng, u x\u01b0\u01a1ng… ch\u1ec9 c\u1ea7n 1 ch\u1ea5n th\u01b0\u01a1ng b\u00ean ngo\u00e0i kh\u00f4ng \u0111\u00e1ng k\u1ec3: tr\u1edf m\u00ecnh khi ng\u1ee7 c\u0169ng \u0111\u1ee7 g\u00e2y ra g\u00e3y x\u01b0\u01a1ng<\/p>\n

3. G\u00e3y do m\u1ecfi (Stress):<\/p>\n

C\u00e1c ch\u1ea5n th\u01b0\u01a1ng nh\u1eb9 nh\u01b0ng nh\u1eafc \u0111i nh\u1eafc l\u1ea1i nhi\u1ec1u l\u1ea7n g\u00e2y ra s\u1ef1 qu\u00e1 s\u1ee9c \u0111\u1ed1i v\u1edbi x\u01b0\u01a1ng l\u00e2u d\u1ea7n d\u1eabn \u0111\u1ebfn g\u00e3y. Hay g\u1eb7p \u1edf v\u1eadn \u0111\u1ed9ng vi\u00ean \u201cma-ra-t\u00f4ng\u201d, ng\u01b0\u1eddi c\u00f4ng nh\u00e2n \u0111\u00e0o \u0111\u1ea5t…<\/p>\n

C\u00e2u 36: Tr\u00ecnh b\u00e0y c\u00e1c di l\u1ec7ch trong g\u00e3y x\u01b0\u01a1ng v\u00e0 n\u00eau c\u00e1c bi\u1ebfn ch\u1ee9ng trong g\u00e3y x\u01b0\u01a1ng?<\/p>\n

I. C\u00e1c di l\u1ec7ch trong g\u00e3y x\u01b0\u01a1ng:<\/p>\n

– Di l\u1ec7ch sang b\u00ean: \u0111o\u1ea1n g\u00e3y di l\u1ec7ch th\u1eb3ng g\u00f3c v\u1edbi tr\u1ee5c d\u1ecdc c\u1ee7a x\u01b0\u01a1ng<\/p>\n

– Di l\u1ec7ch d\u1ecdc tr\u1ee5c ch\u1ed3ng ng\u1eafn: c\u00e1c \u0111o\u1ea1n g\u00e3y di l\u1ec7ch d\u1ecdc theo tr\u1ee5c x\u01b0\u01a1ng ti\u1ebfn s\u00e1t l\u1ea1i nhau.<\/p>\n

– Di l\u1ec7ch d\u1ecdc tr\u1ee5c xa nhau: c\u00e1c \u0111o\u1ea1n g\u00e3y di l\u1ec7ch d\u1ecdc tr\u1ee5c r\u1eddi xa nhau. G\u1ecdi t\u1eaft l\u00e0 di l\u1ec7ch xa.<\/p>\n

– Di l\u1ec7ch g\u1ea5p g\u00f3c: tr\u1ee5c hai \u0111o\u1ea1n g\u00e3y t\u1ea1o n\u00ean m\u1ed9t g\u00f3c (th\u01b0\u1eddng t\u00ednh b\u1eb1ng g\u00f3c nh\u1ecdn)<\/p>\n

– Di l\u1ec7ch xoay: \u0111o\u1ea1n g\u00e3y xa di l\u1ec7ch xoay quanh tr\u1ee5c d\u1ecdc c\u1ee7a x\u01b0\u01a1ng.<\/p>\n

M\u1ed9t g\u00e3y x\u01b0\u01a1ng c\u00f3 th\u1ec3 c\u00f3 1 ho\u1eb7c nhi\u1ec1u di l\u1ec7ch (nhi\u1ec1u nh\u1ea5t l\u00e0 4).<\/p>\n

II. Bi\u00ea\u0301n ch\u1ee9ng c\u1ee7a g\u00e3y x\u01b0\u01a1ng:<\/p>\n

1. T\u00e1c \u0111\u1ed9ng l\u00ean c\u00e1c m\u1ea1ch m\u00e1u<\/p>\n

– \u1ede b\u1ea5t k\u1ef3 1 g\u00e3y x\u01b0\u01a1ng n\u00e0o c\u00e1c m\u1ea1ch m\u00e1u trong t\u1ee7y x\u01b0\u01a1ng, trong x\u01b0\u01a1ng v\u00e0 \u1edf v\u00f9ng m\u00e0ng x\u01b0\u01a1ng \u0111\u1ec1u b\u1ecb \u0111\u1ee9t. Ngo\u00e0i ra l\u1ef1c ch\u1ea5n th\u01b0\u01a1ng c\u00f2n c\u00f3 th\u1ec3 g\u00e2y ch\u1ea3y m\u00e1u th\u00eam c\u00e1c m\u00f4 m\u1ec1m xung quanh. C\u00e1c ch\u1ea3y m\u00e1u \u0111\u00f3 t\u1ea1o n\u00ean m\u00e1u t\u1ee5 v\u00f9ng g\u00e3y x\u01b0\u01a1ng (g\u1ecdi l\u00e0 \u1ed5 g\u00e3y). N\u1ebfu l\u00e0 c\u00e1c x\u01b0\u01a1ng l\u1edbn b\u1ecb g\u00e3y, s\u1ef1 ch\u1ea3y m\u00e1u nhi\u1ec1u s\u1ebd g\u00e2y m\u1ea5t m\u00e1u \u0111\u00e1ng k\u1ec3 v\u00e0 n\u1ea1n nh\u00e2n c\u00f3 th\u1ec3 b\u1ecb cho\u00e1ng. G\u00e3y k\u00edn kh\u00f4ng th\u1ea5y m\u00e1u ch\u1ea3y ra ngo\u00e0i nh\u01b0ng l\u01b0\u1ee3ng m\u00e1u t\u1ee5 trong \u1ed5 g\u00e3y kh\u00f4ng c\u00f2n tham gia v\u00e0o l\u01b0u th\u00f4ng tu\u1ea7n ho\u00e0n n\u00ean xem nh\u01b0 \u0111\u00e3 m\u1ea5t.<\/p>\n

– G\u00e3y x\u01b0\u01a1ng v\u1eeba c\u00f3 \u0111\u1ee9t m\u1ea1ch m\u00e1u trong \u1ed1ng t\u1ee7y v\u1eeba c\u00f3 d\u1eadp t\u1ee7y n\u00ean c\u0169ng c\u00f3 kh\u1ea3 n\u0103ng m\u1ee1 c\u1ee7a t\u1ee7y x\u01b0\u01a1ng tr\u00e0n v\u00e0o trong m\u00e1u g\u00e2y h\u1ed9i ch\u1ee9ng t\u1eafc m\u1ea1ch m\u00e1u do m\u1ee1. H\u1ed9i ch\u1ee9ng n\u00e0y chi\u1ebfm 50% t\u1ed5ng s\u1ed1 t\u1eafc m\u1ea1ch m\u00e1u do m\u1ee1, l\u00e0 1 nguy\u00ean nh\u00e2n kh\u00e1c c\u00f3 th\u1ec3 l\u00e0m ch\u1ebft n\u1ea1n nh\u00e2n g\u00e3y x\u01b0\u01a1ng.<\/p>\n

– M\u00e1u t\u1ee5 v\u1eebng g\u00e3y x\u01b0\u01a1ng n\u1ebfu \u00edt th\u00ec v\u00e0i ng\u00e0y sau ch\u1ea5n th\u01b0\u01a1ng s\u1ebd lan ra d\u01b0\u1edbi da t\u1ea1o n\u00ean d\u1ea5u hi\u1ec7u b\u1ea7m t\u00edm mu\u1ed9n d\u01b0\u1edbi da r\u1ed3i h\u1ebft d\u1ea7n. N\u1ebfu m\u00e1u t\u1ee5 l\u1edbn s\u1ebd th\u1ea5y s\u01b0ng n\u1ec1 v\u00e0 b\u1ea7m t\u00edm d\u01b0\u1edbi da s\u1edbm, t\u1ea1o l\u1ef1c c\u0103ng \u0111\u00e8 \u00e9p g\u00e2y c\u1ea3n tr\u1edf l\u01b0u th\u00f4ng m\u00e1u t\u1ea1i ch\u1ed7. S\u01b0ng n\u1ec1 qu\u00e1 nhi\u1ec1u c\u00f3 th\u1ec3 \u0111e d\u1ecda g\u00e2y h.ch\u1ee9ng ch\u00e8n \u00e9p khoang n\u1eb7ng h\u01a1n s\u1ebd g\u00e2y ho\u1ea1i t\u1eed \u0111o\u1ea1n chi n\u01a1i g\u00e3y xg, v\u00e0 c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n g\u00e2y h\u1ed9i ch\u1ee9ng r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng.<\/p>\n

– Ch\u00e8n \u00e9p l\u01b0u th\u00f4ng m\u00e1u do m\u00e1u t\u1ee5 c\u0169ng g\u00f3p ph\u1ea7n g\u00e2y thi\u1ebfu oxy t\u1ea1i v\u00f9ng g\u00e3y x\u01b0\u01a1ng, n\u1ebfu thi\u1ebfu \u0111\u00e1ng k\u1ec3 s\u1ebd c\u1ea3n tr\u1edf c\u01a1 th\u1ec3 ch\u1ed1ng nhi\u1ec5m tr\u00f9ng n\u1ebfu l\u00e0 g\u00e3y x\u01b0\u01a1ng h\u1edf. N\u1ebfu c\u00e1c m\u1ea1ch m\u00e1u ch\u00ednh b\u1ecb \u0111\u1ee9t haowjc th\u1ee7ng th\u00ec c\u00e1c nguy c\u01a1 n\u00f3i tr\u00ean c\u00e0ng l\u1edbn.<\/p>\n

2. T\u00e1c \u0111\u1ed9ng l\u00ean c\u01a1 xung quanh<\/p>\n

– C\u00e1c c\u01a1 quanh v\u00f9ng g\u00e3y x\u01b0\u01a1ng c\u00f3 th\u1ec3 b\u1ecb th\u01b0\u01a1ng t\u00edch do t\u00e1c nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng. Ngo\u00e0i ra s\u1ef1 ph\u00f9 n\u1ec1 g\u00e2y ch\u00e8n \u00e9p l\u01b0u th\u00f4ng m\u00e1u c\u00f3 th\u1ec3 g\u00e2y thi\u1ebfu m\u00e1u \u1edf c\u01a1 v\u00e0 l\u00e0m c\u01a1 b\u1ecb ho\u1ea1i t\u1eed ho\u1eb7c co r\u00fat c\u01a1. N\u1ebfu x\u01b0\u01a1ng g\u00e3y c\u00f3 di l\u1ec7ch ch\u1ed3ng l\u00e0m x\u01b0\u01a1ng ng\u1eafn \u0111i th\u00ec c\u00e1c c\u01a1 xung quanh s\u1ebd ch\u00f9ng ra v\u00e0 l\u00e2u d\u1ea7n s\u1ebd b\u1ecb co ng\u1eafn l\u1ea1i.<\/p>\n

– B\u1ea5t k\u1ef3 1 k\u00edch th\u00edch \u0111au n\u00e0o (x\u01b0\u01a1ng g\u00e3y kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ea5t \u0111\u1ed9ng, v\u1eadn chuy\u1ec3n v\u1ed9i v\u00e3…) c\u00e0ng l\u00e0m cho c\u00e1c c\u01a1 co ng\u1eafn th\u00eam. Nh\u01b0 v\u1eady s\u1ef1 co c\u01a1 ph\u1ea3n \u1ee9ng n\u00e0y s\u1ebd g\u00e2y kh\u00f3 kh\u0103n cho \u0111i\u1ec1u tr\u1ecb k\u00e9o n\u1eafn c\u00e1c di l\u1ec7ch; \u0111\u1ec3 c\u00e0ng mu\u1ed9n co c\u01a1 c\u00e0ng nhi\u1ec1u th\u00ec k\u00e9o ng\u1eafn c\u00e0ng kh\u00f3.<\/p>\n

– T\u1ed1t nh\u1ea5t l\u00e0 n\u00ean k\u00e9o n\u1eafn c\u1ea5p c\u1ee9u s\u1edbm c\u00e1c g\u00e3y x\u01b0\u01a1ng c\u00f3 di l\u1ec7ch g\u1eadp g\u00f3c v\u00e0 di l\u1ec7ch ch\u1ed3ng ng\u1eafn, nh\u1ea5t l\u00e0 \u1edf n\u1ea1n nh\u00e2n c\u00f3 c\u00e1c c\u01a1 to kh\u1ecfe, khi c\u00e1c c\u01a1 ch\u01b0a c\u00f3 ph\u1ea3n \u1ee9ng ho\u1eb7c s\u1ef1 co c\u01a1 ch\u01b0a m\u1ea1nh.<\/p>\n

3. T\u00e1c \u0111\u1ed9ng l\u00ean c\u00e1c d\u00e2y th\u1ea7n kinh xung quanh<\/p>\n

– C\u00e1c d\u00e2y th\u1ea7n kinh xung quanh \u1ed5 g\u00e3y c\u00f3 th\u1ec3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng do c\u00e1c t\u00e1c nh\u00e2n tr\u1ef1c ti\u1ebfp ho\u1eb7c gi\u00e1n ti\u1ebfp do x\u01b0\u01a1ng g\u00e3y di l\u1ec7ch va ch\u1ea1m. Th\u1ea7n kinh t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 l\u00e0 r\u00e1ch b\u1ecb \u0111\u1ee9t ho\u1eb7c b\u1ecb k\u00e9o c\u0103ng qu\u00e1 m\u1ee9c<\/p>\n

– S\u1ef1 ch\u00e8n g\u00e2y thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u0169ng c\u00f3 th\u1ec3 g\u00e2y r\u1ed1i lo\u1ea1n v\u1ec1 th\u1ea7n kinh. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y n\u1ebfu nhanh ch\u00f3ng gi\u1ea3i ph\u00f3ng th\u1ea7n kinh kh\u1ecfi b\u1ecb ch\u00e8n \u00e9p th\u00ec c\u00f3 th\u1ec3 tr\u00e1nh \u0111\u01b0\u1ee3c t\u1ed5n th\u01b0\u01a1ng v\u0129nh vi\u1ec5n.<\/p>\n

4. T\u00e1c \u0111\u1ed9ng l\u00ean da<\/p>\n

N\u1ebfu g\u00e3y x\u01b0\u01a1ng c\u00f3 k\u00e8m theo t\u1ed5n th\u01b0\u01a1ng \u1edf da do l\u1ef1c ch\u1ea5n th\u01b0\u01a1ng t\u1eeb b\u00ean ngo\u00e0i g\u00e2y ra ho\u1eb7c do c\u00e1c \u0111o\u1ea1n x\u01b0\u01a1ng g\u00e3y ch\u1ecdc th\u1ee7ng th\u00ec \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i x\u00e1c \u0111\u1ecbnh xem da c\u00f3 c\u00f2n che kin x\u01b0\u01a1ng g\u00e3y kh\u00f4ng hay t\u1ed5n th\u01b0\u01a1ng da \u0111\u00e3 l\u00e0m \u1ed5 g\u00e3y th\u00f4ng v\u1edbi b\u00ean ngo\u00e0i.<\/p>\n

Ch\u1ec9 khi n\u00e0o v\u1ebft th\u01b0\u01a1ng da l\u00e0m \u1ed5 g\u00e3y x\u01b0\u01a1ng th\u00f4ng v\u1edbi b\u00ean ngo\u00e0i th\u00ec m\u1edbi g\u1ecdi l\u00e0 g\u00e3y x\u01b0\u01a1ng h\u1edf v\u00e0 khi \u0111\u00f3 \u1ed5 g\u00e3y m\u1edbi \u0111e d\u1ecda nhi\u1ec5m tr\u00f9ng. Nhi\u1ec5m tr\u00f9ng g\u00e3y x\u01b0\u01a1ng h\u1edf l\u00e0 m\u1ed9t nhi\u1ec5m tr\u00f9ng ngo\u1ea1i khoa.<\/p>\n

T\u00f3m l\u1ea1i c\u00e1c bi\u1ebfn ch\u1ee9ng g\u00e3y x\u01b0\u01a1ng \u0111\u01b0\u1ee3c chia l\u00e0m 2 nh\u00f3m:<\/p>\n

\u00d8 C\u00e1c bi\u1ebfn ch\u1ee9ng \u0111e d\u1ecda t\u1ee9c th\u00ec t\u00ednh m\u1ea1ng c\u1ee7a n\u1ea1n nh\u00e2n: cho\u00e1ng ch\u1ea5n th\u01b0\u01a1ng, t\u1eafc m\u1ea1ch m\u00e1u do m\u1ee1<\/p>\n

\u00d8 C\u00e1c bi\u1ebfn ch\u1ee9ng \u1ea3nh h\u01b0\u1edfng ch\u1ee7 y\u1ebfu \u0111\u1ebfn v\u00f9ng chi b\u1ecb ch\u1ea5n th\u01b0\u01a1ng: h\u1ed9i ch\u1ee9ng ch\u00e8n \u00e9p khoang, t\u1ed5n th\u01b0\u01a1ng c\u00e1c m\u1ea1ch m\u00e1u l\u1edbn ch\u00ednh, t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ngo\u1ea1i bi\u00ean, g\u00e3y x\u01b0\u01a1ng h\u1edf v\u00e0 nhi\u1ec5m tr\u00f9ng, h\u1ed9i ch\u1ee9ng r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng.<\/p>\n

C\u00e2u 24: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 bi\u1ebfn ch\u1ee9ng g\u00e3y x\u01b0\u01a1ng h\u1edf?<\/p>\n

I. Tri\u1ec7u ch\u1ee9ng<\/p>\n

1. L\u00e2m s\u00e0ng: ch\u1ea9n \u0111o\u00e1n g\u00e3y x\u01b0\u01a1ng h\u1edf tr\u00ean l\u00e2m s\u00e0ng ph\u1ea3i c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u:<\/p>\n

– C\u00f3 v\u1ebft th\u01b0\u01a1ng.<\/p>\n

– C\u00f3 g\u00e3y x\u01b0\u01a1ng.<\/p>\n

– C\u00f3 th\u00f4ng \u1ed5 g\u00e3y qua v\u1ebft th\u01b0\u01a1ng ra ngo\u00e0i.<\/p>\n

a. V\u1ebft th\u01b0\u01a1ng:<\/p>\n

V\u1ebft th\u01b0\u01a1ng c\u00f3 th\u1ec3 nh\u1ecf hay l\u1edbn, qua v\u1ebft th\u01b0\u01a1ng ch\u00fang ta c\u00f3 th\u1ec3 th\u1ea5y \u0111\u1ea7u x\u01b0\u01a1ng g\u00e3y nh\u01b0ng \u0111\u1eb7c bi\u1ec7t ph\u1ea3i xem v\u1ebft th\u01b0\u01a1ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng g\u00ec kh\u00e1c kh\u00f4ng nh\u01b0 m\u00e1u ph\u00fan th\u00e0nh v\u00f2i do t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch ph\u1ed1i h\u1ee3p,\u2026<\/p>\n

b. G\u00e3y x\u01b0\u01a1ng: c\u00f3 6 tri\u1ec7u ch\u1ee9ng g\u00e3y x\u01b0\u01a1ng:<\/p>\n

– Tri\u1ec7u ch\u1ee9ng t\u01b0\u01a1ng \u0111\u1ed1i g\u1ed3m: S\u01b0ng – \u0110au v\u00e0 Gi\u1ea3m ho\u1eb7c m\u1ea5t c\u01a1 n\u0103ng.<\/p>\n

– Tri\u1ec7u ch\u1ee9ng tuy\u1ec7t \u0111\u1ed1i g\u1ed3m: Bi\u1ebfn d\u1ea1ng – C\u1eed \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng v\u00e0 Ti\u1ebfng l\u1ea1o x\u1ea1o c\u1ee7a x\u01b0\u01a1ng g\u00e3y.<\/p>\n

c. \u1ed4 g\u00e3y th\u00f4ng qua v\u1ebft th\u01b0\u01a1ng ra ngo\u00e0i: trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y ch\u00fang ta c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c d\u1ea5u hi\u1ec7u sau:<\/p>\n

– C\u00f3 khi n\u00ecn th\u1ea5y \u0111\u1ea7u x\u01b0\u01a1ng g\u00e3y.<\/p>\n

– M\u00e1u ch\u1ea3y qua v\u1ebft th\u01b0\u01a1ng c\u00f3 v\u00e1ng m\u1ee1 c\u1ee7a tu\u1ef7 x\u01b0\u01a1ng<\/p>\n

– V\u1ebft th\u01b0\u01a1ng c\u00f3 ho\u1ea3 kh\u00ed g\u00e2y g\u00e3y x\u01b0\u01a1ng th\u00ec lu\u00f4n lu\u00f4n c\u00f3 \u1ed5 g\u00e3y th\u1ed3n v\u1edbi v\u1ebft th\u01b0\u01a1ng ra ngo\u00e0i. C\u00f3 khi kh\u00f4ng ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c g\u00e3y x\u01b0\u01a1ng ho\u1ebb tr\u00ean l\u00e2m s\u00e0ng ngay t\u1eeb \u0111\u1ea7u, ch\u1ec9 ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c sau khi m\u1ed5 c\u1eaft l\u1ecdc v\u1ebft th\u01b0\u01a1ng<\/p>\n

2. X Quang:<\/p>\n

– Ch\u1ee5p \u00edt nh\u1ea5t hai b\u00ecnh di\u1ec7n v\u00e0 l\u1ea5y c\u1ea3 hai \u0111\u1ea7u x\u01b0\u01a1ng g\u00e3y \u0111\u1ec3 ch\u1ea9n do\u00e1n v\u1ecb tr\u00ed g\u00e3y, \u0111\u01b0\u1eddng g\u00e3y c\u00e1c di l\u1ec7ch.<\/p>\n

– Xquang th\u01b0\u1eddng kh\u00f4ng ch\u1ea9n \u0111o\u00e1n d\u01b0\u1ee3c g\u00e3y x\u01b0\u01a1ng h\u1edf, ch\u1ec9 d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng m\u1edbi ch\u1ea9n \u0111o\u00e1n d\u01b0\u1ee3c g\u00e3y x\u01b0\u01a1ng h\u1edf.<\/p>\n

II. Bi\u1ebfn ch\u1ee9ng: – G\u1ed3m c\u00f3 2 lo\u1ea1i ch\u00ednh:<\/p>\n

* C\u00e1c bi\u1ebfn ch\u1ee9ng to\u00e0n th\u00e2n \u0111e do\u1ea1 t\u00ednh m\u1ea1ng nh\u01b0:<\/p>\n

– Cho\u00e1ng ch\u1ea5n th\u01b0\u01a1ng .<\/p>\n

– T\u1eafc m\u1ea1ch m\u00e1u do m\u1ee1 .<\/p>\n

* C\u00e1c bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed5 nh\u01b0:<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u th\u1ea7n kinh .<\/p>\n

– Ch\u00e8n \u00e9p khoang<\/p>\n

– Nhi\u1ec5m tr\u00f9ng .<\/p>\n

– Can l\u1ec7ch .<\/p>\n

– Kh\u00f4ng li\u1ec1n .<\/p>\n

– R\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng.<\/p>\n

1.Cho\u00e1ng ch\u1ea5n th\u01b0\u01a1ng :<\/p>\n

Do m\u1ea5t m\u00e1u v\u00e0 \u0111au n\u01a1i chi g\u00e3y ,trong g\u00e3y x\u01b0\u01a1ng h\u1edf th\u00ec \u0111au v\u00e0 ch\u1ea3y m\u00e1u nhi\u1ec1u h\u01a1n g\u00e3y x\u01b0\u01a1ng k\u00edn ,n\u1ebfu g\u00e3y nhi\u1ec1u x\u01b0\u01a1ng v\u00e0 g\u00e3y x\u01b0\u01a1ng l\u1edbn th\u00ec d\u1ec5 g\u00e2y n\u00ean cho\u00e1ng v\u00e0 cho\u00e1ng n\u1eb7ng h\u01a1n .<\/p>\n

2.T\u1eafc m\u1ea1ch m\u00e1u do m\u1ee1: \u0110i\u1ec1u ki\u1ec7n g\u00e2y t\u1eafc do m\u1ee1:<\/p>\n

– Cho\u00e1ng do m\u1ea5t m\u00e1u .<\/p>\n

– G\u00e3y x\u01b0\u01a1ng l\u1edbn ho\u1eb7c nhi\u1ec1u x\u01b0\u01a1ng .<\/p>\n

– D\u1eadp n\u00e1t ph\u1ea7n m\u1ec1m lan r\u1ed9ng .<\/p>\n

– X\u01b0\u01a1ng g\u00e3y kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ea5t \u0111\u1ed9ng t\u1ed1t .<\/p>\n

M\u1ee1 trung b\u00ecnh trong m\u00e1u di chuy\u1ec5n g\u00e2y t\u1eafc m\u1ea1ch \u1edf n\u01a1i kh\u00e1c nh\u01b0 : n\u00e3o, ph\u1ed5i ,th\u1eadn …L\u00e0m cho t\u00ecnh tr\u1ea1ng g\u00e3y x\u01b0\u01a1ng c\u00e0ng n\u1eb7ng h\u01a1n v\u00e0 \u0111\u00e2y l\u00e0 m\u00f4t nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong.<\/p>\n

3.Ch\u00e8n \u00e9p khoang:<\/p>\n

– L\u00e0 t\u0103ng \u00e1p l\u1ef1c trong m\u1ed9t hay nhi\u1ec1u khoang l\u00e0m gi\u1ea3m l\u01b0u th\u00f4ng m\u00e1u qua khoang d\u1ea9n \u1edbi thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ,n\u1ebfu \u00e1p l\u1ef1c cao k\u00e9o d\u00e0i s\u1ebd g\u00e2y n\u00ean:<\/p>\n

– C\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u01a1.<\/p>\n

– C\u00e1c r\u1ed1i lo\u1ea1n th\u1ea7n kinh .<\/p>\n

4.Nhi\u1ec5m r\u00f9ng :<\/p>\n

L\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng hay x\u1ea3y ra trong g\u00e3y x\u01b0\u01a1ng h\u1edf v\u00ec c\u00f3 \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i l\u00e0 c\u00f3 m\u00f4 d\u1eadp n\u00e1t v\u00e0 c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a vi tr\u00f9ng.<\/p>\n

5. T\u1ed5n th\u01b0\u01a1ng mach m\u00e1u :<\/p>\n

C\u00e1c m\u1ea1ch m\u00e1u l\u1edbn \u0111i qua v\u00f9ng x\u01b0\u01a1ng g\u00e3y c\u00f3 th\u1ec3 b\u1ecb ch\u00e8n \u00e9p ,b\u1ecb r\u00e1ch hay b\u1ecb \u0111\u1ee9t ,n\u1ebfu \u0111\u1ee9t \u1edf v\u00f9ng kh\u00f4ng c\u00f3 v\u00f2ng n\u1ed1i t\u1ed1t c\u00f3 th\u1ec3 g\u00e2y n\u00ean ho\u1ea1i t\u1eed chi do thi\u1ebfu m\u00e1u.Ngo\u00e0i ra t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u g\u00e2y n\u00ean m\u00e1u t\u1ee5 s\u1ebd l\u00e0 t\u00e1c nh\u00e2n g\u00e2y n\u00ean ch\u00e8n \u00e9p khoang .<\/p>\n

6. T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh :<\/p>\n

– C\u0169ng nh\u01b0 m\u1ea1ch m\u00e1u th\u1ea7n kinh \u0111i qua v\u00f9ng x\u01b0\u01a1ng g\u00e3y c\u00f3 th\u1ec3 b\u1ecb ch\u00e8n \u00e9p ho\u1eb7c r\u00e1ch \u0111\u1ee9t ,ch\u00fang ta hay g\u1eb7p c\u00e1c bi\u1ebfn ch\u1ee9ng ch\u00e8n \u00e9p th\u1ea7n kinh ,\u0111i\u1ec3n h\u00ecnh \u1edf c\u00e1c lo\u1ea1i g\u00e3y x\u01b0\u01a1ng sau:<\/p>\n

– Li\u1ec7t th\u1ea7n kinh trong trong g\u00e1y x\u01b0\u01a1ng c\u00e1nh tay .<\/p>\n

– Li\u1ec7t th\u1ea7n kinh h\u00f4ng khoeo ngo\u00e0i g\u00e3y ch\u1ecfm x\u01b0\u01a1ng m\u00e1c.<\/p>\n

– Li\u1ec7t th\u1ea7n kinh trong g\u00e3y tr\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay,\u2026<\/p>\n

7. C\u00e1c bi\u1ebfn ch\u1ee9ng mu\u1ed9n:<\/p>\n

G\u1ed3m can l\u1ec7ch, kh\u00f4ng li\u1ec1n x\u01b0\u01a1ng, ch\u1eadm li\u1ec1n x\u01b0\u01a1ng v\u00e0 r\u1ed7i lo\u1ea1n dinh d\u01b0\u1ee1ng, c\u00e1c bi\u1ebfn ch\u1ee9ng n\u00e0y th\u01b0\u1eddng li\u00ean quan t\u1edbi t\u1ed5n th\u01b0\u01a1ng ban \u0111\u1ea7u ho\u1eb7c m\u1ed9t ph\u1ea7n do \u0111i\u1ec1u tr\u1ecb, \u1ea3nh h\u01b0\u1edfng kh\u00f4ng t\u1ed1t \u0111\u1ebfn ch\u1ee9c n\u0103ng c\u1ee7a chi g\u00e3y.<\/p>\n

C\u00e2u 45: Tr\u00ecnh b\u00e0y gi\u1ea3i ph\u1ea9u b\u1ec7nh v\u00e0 chu\u1ea9n \u0111o\u00e1n g\u00e3y x\u01b0\u01a1ng h\u1edf (c\u00e2u 24)?<\/p>\n

T\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu b\u1ec7nh c\u1ee7a g\u00e3y x\u01b0\u01a1ng h\u1edf bao g\u1ed3m:<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m.<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u v\u00e0 th\u1ea7n kinh.<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng.<\/p>\n

– T\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng.<\/p>\n

Trong g\u00e3y x\u01b0\u01a1ng h\u1edf c\u00e1c t\u1ed5n th\u01b0\u01a1ng tr\u00ean \u0111\u1ec1u g\u00e2y n\u00ean ch\u1ea3y m\u00e1u, \u0111\u00e2y l\u00e0 v\u1ea5n \u0111\u1ec1 c\u1ea7n quan t\u00e2m nhi\u1ec1u nh\u1ea5t trong g\u00e3y x\u01b0\u01a1ng h\u1edf.<\/p>\n

1. Ch\u1ea3y m\u00e1u:<\/p>\n

– G\u00e3y x\u01b0\u01a1ng n\u00f3i chung \u0111\u1ec1u g\u00e2y n\u00ean ch\u1ea3y m\u00e1u, trong g\u00e3y x\u01b0\u01a1ng h\u1edf m\u00e1u ch\u1ea3y trong x\u01b0\u01a1ng th\u00f4ng ra ngo\u00e0i n\u00ean l\u01b0\u1ee3ng m\u00e1u m\u1ea5t nhi\u1ec1u h\u01a1n. Theo th\u1ed1ng k\u00ea c\u1ee7a Willinegger s\u1ed1 l\u01b0\u1ee3ng m\u00e1u m\u1ea5t nh\u01b0 sau:<\/p>\n

G\u00e3y x\u01b0\u01a1ng c\u1eb3ng ch\u00e2n m\u1ea5t t\u1eeb 300-600 ml.<\/p>\n

G\u00e3y x\u01b0\u01a1ng \u0111\u00f9i m\u1ea5t t\u1eeb 600-1000 ml.<\/p>\n

G\u00e3y x\u01b0\u01a1ng ch\u1eadu m\u1ea5t t\u1eeb 1700-2400 ml.<\/p>\n

– C\u1ed9ng v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c trong g\u00e3y x\u01b0\u01a1ng h\u1edf th\u00ec l\u01b0\u1ee3ng m\u1ea5t m\u00e1u l\u00e0 \u0111\u00e1ng quan t\u00e2m, \u0111\u1eb7c bi\u1ec7t trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m r\u1ed9ng l\u1edbn ho\u1eb7c c\u00f3 t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u th\u00ec l\u01b0\u1ee3ng m\u00e1u m\u1ea5t r\u1ea5t nhi\u1ec1u.<\/p>\n

2. T\u1ed5n th\u01b0\u01a1ng m\u00f4:C\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u00f4 trong g\u00e3y x\u01b0\u01a1ng h\u1edf \u0111\u1ec1u g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng, \u0111\u1ebfn kh\u1ea3 n\u0103ng li\u1ec1n x\u01b0\u01a1ng nh\u01b0 \u0111\u1ee9t d\u1eadp n\u00e1t c\u01a1 g\u00e2y n\u00ean m\u1ea5t v\u1eadn \u0111\u1ed9ng, t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh g\u00e2y li\u1ec7t v\u1eadn \u0111\u1ed9ng v\u00e0 c\u1ea3m gi\u00e1c, t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u g\u00e2y thi\u1ebfu d\u01b0\u1ee1ng, t\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng kh\u1edbp g\u00e2y l\u1ecfng kh\u1edbp ho\u1eb7c gi\u1ea3m ch\u1ee9c n\u0103ng kh\u1edbp, t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng n\u1ebfu ph\u1ee9c t\u1ea1p g\u00e2y n\u00ean ch\u1eadm li\u1ec1n x\u01b0\u01a1ng ho\u1eb7c kh\u00f4ng li\u1ec1n x\u01b0\u01a1ng. Ngo\u00e0i ra t\u1ed5n th\u01b0\u01a1ng \u1edf c\u00e1c m\u00f4 c\u0169ng g\u00e2y n\u00ean ch\u1ea3y m\u00e1u t\u1ea1o n\u00ean m\u00e1u t\u1ee5 trong m\u00f4 k\u00e8m v\u1edbi c\u00e1c m\u00f4 d\u1eadp n\u00e1t l\u00e0 m\u00f4i tr\u01b0\u1eddng ph\u00e1t tri\u1ec3n t\u1ed1t c\u1ee7a vi tr\u00f9ng g\u00e2y nhi\u1ec5m tr\u00f9ng.<\/p>\n

3. Nhi\u1ec5m tr\u00f9ng v\u1ebft th\u01b0\u01a1ng:<\/p>\n

– \u0110\u00e2y l\u00e0 v\u1ea5n \u0111\u1ec1 kh\u00e1c bi\u1ec7t c\u1ee7a g\u00e3y x\u01b0\u01a1ng h\u1edf so v\u1edbi g\u00e3y x\u01b0\u01a1ng k\u00edn. Tuy nhi\u00ean mu\u1ed1n c\u00f3 nhi\u1ec5m tr\u00f9ng ph\u1ea3i c\u00f3 2 \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i:<\/p>\n

+ C\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a vi khu\u1ea9n t\u1ea1i v\u1ebft th\u01b0\u01a1ng.<\/p>\n

+ C\u00f3 m\u00f4i tr\u01b0\u1eddng thu\u1eadn l\u1ee3i \u0111\u1ec3 vi tr\u00f9ng ph\u00e1t tri\u1ec3n.<\/p>\n

– Trong g\u00e3y x\u01b0\u01a1ng h\u1edf theo Muller ch\u1ec9 c\u00f3 1\/3 tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng h\u1edf \u0111\u01b0\u1ee3c nu\u00f4i c\u1ea5y c\u00f3 vi tr\u00f9ng trong nh\u1eefng gi\u1edd \u0111\u1ea7u, nh\u01b0ng trong g\u00e3y x\u01b0\u01a1ng h\u1edf c\u00f3 m\u00f4i tr\u01b0\u1eddng thu\u1eadn l\u1ee3i \u0111\u1ec3 vi tr\u00f9ng ph\u00e1t tri\u1ec3n nh\u01b0 m\u00e1u t\u1ee5 v\u00e0 m\u00f4 d\u1eadp n\u00e1t; ngo\u00e0i ra c\u00e1c m\u1ea3nh x\u01b0\u01a1ng r\u1eddi trong g\u00e3y x\u01b0\u01a1ng h\u1edf \u0111\u00f3ng vai tr\u00f2 th\u1ee5 \u0111\u1ed9ng trong nhi\u1ec5m tr\u00f9ng v\u1ebft th\u01b0\u01a1ng:<\/p>\n

+ N\u1ebfu v\u1ebft th\u01b0\u01a1ng kh\u00f4ng nhi\u1ec5m tr\u00f9ng th\u00ec m\u1ea3nh x\u01b0\u01a1ng r\u1eddi kh\u00f4ng ch\u1ebft v\u00e0 c\u00f2n gi\u00fap cho qu\u00e1 tr\u00ecnh li\u1ec1n x\u01b0\u01a1ng t\u1ed1t h\u01a1n do t\u0103ng di\u1ec7n t\u00edch ti\u1ebfp x\u00fac c\u1ee7a m\u1eb7t g\u00e3y .<\/p>\n

+ N\u1ebfu v\u1ebft th\u01b0\u01a1ng nhi\u1ec5m tr\u00f9ng: m\u1ea3nh x\u01b0\u01a1ng r\u1eddi s\u1ebd th\u00e0nh x\u01b0\u01a1ng ch\u1ebft v\u00e0 duy tr\u00ec nhi\u1ec5m tr\u00f9ng.<\/p>\n

4. S\u1ef1 li\u1ec1n v\u1ebft th\u01b0\u01a1ng:M\u1ed9t v\u1ebft th\u01b0\u01a1ng mu\u1ed1n li\u1ec1n t\u1ed1t ph\u1ea3i c\u00f3 c\u00e1c \u0111i\u1ec1u ki\u1ec7n sau:<\/p>\n

– V\u1ebft th\u01b0\u01a1ng kh\u00f4ng b\u1ecb nhi\u1ec5m tr\u00f9ng.<\/p>\n

– Trong v\u1ebft th\u01b0\u01a1ng kh\u00f4ng c\u00f3 ngo\u1ea1i v\u1eadt.<\/p>\n

– Trong v\u1ebft th\u01b0\u01a1ng kh\u00f4ng c\u00f3 m\u00e1u t\u1ee5 v\u00e0 c\u00e1c m\u00f4 ho\u1ea1i t\u1eed.<\/p>\n

– M\u00e9p v\u1ebft th\u01b0\u01a1ng \u0111\u01b0\u1ee3c nu\u00f4i d\u01b0\u1ee1ng t\u1ed1t.<\/p>\n

– Kh\u00e2u v\u1ebft th\u01b0\u01a1ng kh\u00f4ng b\u1ecb c\u0103ng.<\/p>\n

5. S\u1ef1 li\u1ec1n x\u01b0\u01a1ng:C\u00e1c y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i t\u1ea1o n\u00ean li\u1ec1n x\u01b0\u01a1ng:<\/p>\n

– Y\u1ebfu t\u1ed1 sinh h\u1ecdc: L\u00e0 m\u00e1u nu\u00f4i d\u01b0\u1ee1ng \u1ed5 g\u00e3y th\u1eadt t\u1ed1t. Trong g\u00e3y x\u01b0\u01a1ng h\u1edf c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 kh\u00f4ng t\u1ed1t l\u00e0 nhi\u1ec5m tr\u00f9ng, d\u1eadp m\u00f4 m\u1ec1m xung quanh v\u00e0 m\u1ea5t x\u01b0\u01a1ng s\u1ebd l\u00e0m cho thi\u1ebfu nu\u00f4i d\u01b0\u1ee1ng \u1ed5 g\u00e3y, \u0111\u00e2y l\u00e0 \u0111i\u1ec1u ki\u1ec7n kh\u00f4ng t\u1ed1t cho v\u1ea5n \u0111\u1ec1 li\u1ec1n x\u01b0\u01a1ng.<\/p>\n

– Y\u1ebfu t\u1ed1 c\u01a1 h\u1ecdc: L\u00e0 s\u1ef1 c\u1ed1 \u0111\u1ecbnh \u1ed5 g\u00e3y, trong g\u00e3y x\u01b0\u01a1ng h\u1edf th\u01b0\u1eddng x\u01b0\u01a1ng g\u00e3y ph\u1ee9c t\u1ea1p c\u00f3 khi m\u1ea5t \u0111o\u1ea1n x\u01b0\u01a1ng s\u1ebd g\u00e2y kh\u00f3 kh\u0103n cho vi\u1ec7c c\u1ed1 \u0111\u1ecbnh \u1ed5 g\u00e3y \u1ea3nh h\u01b0\u1edfng kh\u00f4ng t\u1ed1t \u0111\u1ebfn qu\u00e1 tr\u00ecnh li\u1ec1n x\u01b0\u01a1ng.<\/p>\n

C\u00e2u 15: Tr\u00ecnh b\u00e0y ph\u00e2n lo\u1ea1i theo Gustilo v\u00e0 ch\u1ec9 s\u1ed1 ch\u1ea5n th\u01b0\u01a1ng trong g\u00e3y x\u01b0\u01a1ng h\u1edf?<\/p>\n

1. Ph\u00e2n lo\u1ea1i theo GUSTILO (1984):Chia g\u00e3y x\u01b0\u01a1ng h\u1edf l\u00e0m 3 m\u1ee9c \u0111\u1ed9, ri\u00eang \u0111\u1ed9 IIIchia l\u00e0m 3 nh\u00f3m: IIIa, IIIb, IIIc.<\/p>\n

1.1-\u0110\u1ed9 I:<\/p>\n

-Da r\u00e1ch kho\u1ea3ng 1 cm.<\/p>\n

-V\u1ebft th\u01b0\u01a1ng ho\u00e0n to\u00e0n s\u1ea1ch, h\u1ea7u h\u1ebft do g\u00e3y h\u1edf t\u1eeb trong ra.<\/p>\n

-\u0110\u1ee5ng d\u1eadp c\u01a1 t\u1ed1i thi\u1ec3u.<\/p>\n

-\u0110\u01b0\u1eddng g\u00e3y x\u01b0\u01a1ng l\u00e0 \u0111\u01b0\u1eddng ngang \u0111\u01a1n gi\u1ea3n ho\u1eb7c ch\u00e9o ng\u1eafn<\/p>\n

1.2-\u0110\u1ed9 II:<\/p>\n

-T\u1ed5n th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m r\u1ed9ng, c\u00f3 th\u1ec3 l\u00e0 l\u00f3c da c\u00f2n cu\u1ed1ng ho\u1eb7c l\u00f3c h\u1eb3n v\u1ea1t da.<\/p>\n

-V\u1ebft r\u00e1ch da h\u01a1n 1cm.<\/p>\n

-C\u01a1 \u0111\u1ee5ng d\u1eadp t\u1eeb nh\u1eb9 \u0111\u1ebfn v\u1eeba, c\u00f3 khi c\u00f3 ch\u00e8n \u00e9p khoang.<\/p>\n

-X\u01b0\u01a1ng g\u00e3y v\u1edbi \u0111\u01b0\u1eddng g\u00e3y ngang \u0111\u01a1n gi\u1ea3n ho\u1eb7c ch\u00e9o ng\u1eafn v\u1edbi m\u1ea3nh nh\u1ecf.<\/p>\n

1.3-\u0110\u1ed9 III: T\u1ed5n th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m r\u1ed9ng bao g\u1ed3m c\u1ea3 c\u01a1, da v\u00e0 c\u1ea5u tr\u00fac th\u1ea7n kinh m\u1ea1ch m\u00e1u. T\u1ed1c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng cao \u0111\u01b0a t\u1edbi d\u1eadp n\u00e1t ph\u1ea7n m\u1ec1m nhi\u1ec1u v\u00e0 h\u1ee3p th\u00e0nh ch\u00e8n\u00e9p d\u1eef d\u1ed9i. Lo\u1ea1i n\u00e0y g\u1ed3m 3 nh\u00f3m:<\/p>\n

-IIIa: V\u1ebft r\u00e1ch ph\u1ea7n m\u1ec1m r\u1ed9ng t\u01b0\u01a1ng \u1ee9ng v\u1edbi v\u00f9ng x\u01b0\u01a1ng g\u00e3y ho\u1eb7c v\u1ebft th\u01b0\u01a1ng trongt\u1ea7m \u0111\u1ea1n b\u1eafn g\u1ea7n.<\/p>\n

-IIIb: V\u1ebft r\u00e1ch ph\u1ea7n m\u1ec1m r\u1ed9ng, v\u1edbi m\u00e0ng x\u01b0\u01a1ng b\u1ecb tr\u00f3c ra v\u00e0 \u0111\u1ea7u x\u01b0\u01a1ng g\u00e3y b\u1ecb l\u1ed9 rango\u00e0i. V\u00f9ng g\u00e3y x\u01b0\u01a1ng b\u1ecb nhi\u1ec5m b\u1ea9n nhi\u1ec1u.<\/p>\n

-IIIc: V\u1ebft th\u01b0\u01a1ng d\u1eadp n\u00e1t nhi\u1ec1u, x\u01b0\u01a1ng g\u00e3y ph\u1ee9c t\u1ea1p v\u00e0 c\u00f3 t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u c\u1ea7nph\u1ea3i ph\u1ee5c h\u1ed3i.<\/p>\n

N\u00f3i chung ph\u00e2n chia theo Gustilo c\u0169ng nh\u01b0 Tscherne \u0111\u1ec1u l\u1ea5y t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m l\u00e0ch\u00ednh, k\u1ebft h\u1ee3p v\u1edbi m\u1ee9c \u0111\u1ed9 c\u1ee7a x\u01b0\u01a1ng g\u00e3y (\u0111\u01a1n gi\u1ea3n hay ph\u1ee9c t\u1ea1p). Trong \u0111\u00f3 g\u00e3y h\u1edf\u0111\u1ed9 IV l\u00e0 m\u1ed9t h\u00ecnh th\u00e1i \u0111\u1eb7c bi\u1ec7t.<\/p>\n

2. Ch\u1ec9 s\u1ed1 ch\u1ea5n th\u01b0\u01a1ng:<\/p>\n

Trong g\u00e3y x\u01b0\u01a1ng h\u1edf c\u00f3 kho\u1ea3ng 40-70% tr\u01b0\u1eddng h\u1ee3p c\u00f3 k\u00e8m v\u1edbi t\u1ed5n th\u01b0\u01a1ng c\u01a1 quankh\u00e1c (\u0111\u1ea7u, ng\u1ef1c , b\u1ee5ng\u2026) g\u1ecdi chung l\u00e0 \u0111a th\u01b0\u01a1ng.<\/p>\n

\u0110\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng n\u1eb7ng haynh\u1eb9 c\u00f3 nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng hay kh\u00f4ng, d\u1ef1a v\u00e0o c\u00e1c d\u1ea5u hi\u1ec7u sinh t\u1ed3n \u0111\u1ec3 cho\u0111i\u1ec3m. \u0110i\u1ec3m s\u1ed1 n\u1ea7y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ch\u1ec9 s\u1ed1 ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n

Ch\u1ec9 s\u1ed1 ch\u1ea5n th\u01b0\u01a1ng l\u00e0 k\u1ebft qu\u1ea3 t\u1ed5ng h\u1ee3p c\u1ee7a 5 ch\u1ec9 s\u1ed1 theo m\u1ed9t thang \u0111i\u1ec3m cho tr\u01b0\u1edbc khikh\u00e1m v\u1ec1 nh\u1ecbp th\u1edf, c\u00e1ch th\u1edf, huy\u1ebft \u00e1p, tu\u1ea7n ho\u00e0n ngo\u1ea1i vi v\u00e0 ch\u1ec9 s\u1ed1 m\u00ea Glasgow.<\/p>\n

A.Nh\u1ecbp th\u1edf: \u0111\u1ebfm s\u1ed1 l\u1ea7n th\u1edf trong 15 gi\u00e2y<\/p>\n

+ 10-24 l\u1ea7n: 4 \u0111i\u1ec3m<\/p>\n

+ 25-35 l\u1ea7n: 3 \u0111i\u1ec3m<\/p>\n

+ >35 l\u1ea7n: 2 \u0111i\u1ec3m<\/p>\n

+ <10 l\u1ea7n: 1 \u0111i\u1ec3m + 0 l\u1ea7n: 0 \u0111i\u1ec3m B.C\u00e1ch th\u1edf B\u00ecnh th\u01b0\u1eddng: 1 \u0111i\u1ec3m Co k\u00e9o: 0 \u0111i\u1ec3m C.Huy\u1ebft \u00e1p t\u00e2m thu:K\u1ebft qu\u1ea3 \u0111o \u0111\u01b0\u1ee3c (mm Hg) + >90mmHg: 4 \u0111i\u1ec3m<\/p>\n

+ 70-80 mmHg: 3 \u0111i\u1ec3m<\/p>\n

+ 50-69 mmHg: 2 \u0111i\u1ec3m<\/p>\n

+ <50 mmHg: 1 \u0111i\u1ec3m + 0 mmHg: 0 \u0111i\u1ec3m D.Tu\u1ea7n ho\u00e0n mao qu\u1ea3n ngo\u1ea1i vi:D\u1ea5u b\u1ea5m m\u00f3ng tay, ho\u1eb7c b\u1ea5mv\u00e0om\u00f4i r\u1ed3i bu\u00f4ng ra H\u1ed3ng l\u1ea1i ngay: 2 \u0111i\u1ec3m H\u1ed3ng l\u1ea1i ch\u1eadm >2 gi\u00e2y: 1 \u0111i\u1ec3m<\/p>\n

Kh\u00f4ng h\u1ed3ng l\u1ea1i: 0 \u0111i\u1ec3m<\/p>\n

E.Ch\u1ec9 s\u1ed1 Glasgow:<\/p>\n

K\u1ebft qu\u1ea3 kh\u00e1m \u0111\u01b0\u1ee3c: + 14-15: 5 \u0111i\u1ec3m<\/p>\n

+ 11-13: 4 \u0111i\u1ec3m<\/p>\n

+ 08-10: 3 \u0111i\u1ec3m<\/p>\n

+ 05-07: 2 \u0111i\u1ec3m<\/p>\n

+ 03-04: 1 \u0111i\u1ec3m<\/p>\n

Ch\u1ec9 s\u1ed1 Glasgow (Glasgow coma score: GCS) l\u00e0 m\u1ed9t ch\u1ec9 s\u1ed1 d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9n\u1eb7ng, nh\u1eb9 trong ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, kh\u1ea3o s\u00e1t theo 3 ti\u00eau chu\u1ea9n: v\u1eadn \u0111\u1ed9ng khi k\u00edchth\u00edch, \u0111\u00e1p \u1ee9ng ng\u00f4n ng\u1eef khi h\u1ecfi v\u00e0 m\u1edf m\u1eaft khi \u0111\u01b0\u1ee3c kh\u00e1m.(xem th\u00eam t\u00e0i li\u1ec7u v\u1ec1 ngo\u1ea1ith\u1ea7n kinh)<\/p>\n

GCS<4: 85% tr\u01b0\u1eddng h\u1ee3p s\u1ebd ch\u1ebft trong v\u00f2ng 24 gi\u1edd. GCS t\u1eeb 4-8: Ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o n\u1eb7ng GCS 8-11: B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 s\u1ed1ng \u0111\u01b0\u1ee3c nh\u01b0ng c\u00f3 di ch\u1ee9ng GCS>12: Ti\u00ean l\u01b0\u1ee3ng t\u1ed1t, nh\u01b0ng c\u1ea7n theo d\u00f5i th\u00eam<\/p>\n

GCS=15: B\u00ecnh th\u01b0\u1eddng<\/p>\n

TS= T\u1ed5ng h\u1ee3p c\u00e1c \u0111i\u1ec3m A+B+C+D+E<\/p>\n

Ch\u1ec9 s\u1ed1 n\u00e0y kho\u1ea3ng 12 c\u00f3 th\u1ec3 n\u00f3i b\u1ec7nh nh\u00e2n n\u1eb7ng c\u1ea7n chuy\u1ec3n \u0111\u1ebfn trung t\u00e2m chuy\u00eankhoa \u0111i\u1ec1u tr\u1ecb.<\/p>\n

Ch\u00fa \u00fd: Ch\u1ec9 s\u1ed1 TS v\u00e0 GCS ch\u1ec9 c\u00f3 gi\u00e1 tr\u1ecb trong v\u00f2ng 24 gi\u1edd. C\u1ea7n kh\u00e1m l\u1ea1i v\u00e0 theo d\u00f5is\u00e1t.<\/p>\n","protected":false},"excerpt":{"rendered":"

C\u00e2u 1: Tr\u00ecnh b\u00e0y tri\u1ec7u ch\u1ee9ng v\u00e0 bi\u1ebfn ch\u1ee9ng v\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m? C\u00e2u 2: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a v\u00e0 ph\u00e2n lo\u1ea1i v\u1ebft th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m? C\u00e2u 3: Tr\u00ecnh b\u00e0y c\u00e1c giai \u0111o\u1ea1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ecfng? C\u00e2u 4: Tr\u00ecnh b\u00e0y c\u00e1c giai \u0111o\u1ea1n c\u1ee7a m\u00ea? C\u00e2u 5: Tr\u00ecnh b\u00e0y c\u00e1ch ph\u00e2n lo\u1ea1i vi\u00eam ph\u00fac …<\/p>\n","protected":false},"author":10,"featured_media":2136,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[57,58],"tags":[],"class_list":["post-2277","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-ngoai-khoa","category-ngoai-co-so"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2277","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=2277"}],"version-history":[{"count":4,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2277\/revisions"}],"predecessor-version":[{"id":2294,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2277\/revisions\/2294"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/2136"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=2277"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=2277"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=2277"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}