{"id":801,"date":"2021-08-29T11:51:07","date_gmt":"2021-08-29T11:51:07","guid":{"rendered":"http:\/\/phauthuatnhi.vn\/vi\/?p=801"},"modified":"2021-08-29T11:51:10","modified_gmt":"2021-08-29T11:51:10","slug":"chan-thuong-gan-o-tre-em","status":"publish","type":"post","link":"http:\/\/phauthuatnhi.vn\/vi\/cacloaibenh\/chan-thuong-gan-o-tre-em\/","title":{"rendered":"Ch\u1ea5n th\u01b0\u01a1ng gan \u1edf tr\u1ebb em"},"content":{"rendered":"\n<p class=\"has-medium-font-size\"><strong>\u0110\u1ea1i c\u01b0\u01a1ng<\/strong><\/p>\n\n\n\n<ul><li>B\u1ee5ng l\u00e0 m\u1ed9t trong ba n\u01a1i th\u01b0\u1eddng b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u1edf tr\u1ebb em, sau \u0111\u1ea7u v\u00e0 tay ch\u00e2n, c\u0169ng l\u00e0 n\u01a1i d\u1ec5 b\u1ecb b\u1ecf s\u00f3t nh\u1eefng th\u01b0\u01a1ng t\u1ed5n g\u00e2y t\u1eed vong trong ch\u1ea5n th\u01b0\u01a1ng \u1edf tr\u1ebb em.<\/li><li>Ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng k\u00edn chi\u1ebfm 80%, trong \u0111\u00f3 ch\u1ea5n th\u01b0\u01a1ng gan chi\u1ebfm 1\/3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ea5n th\u01b0\u01a1ng b\u1ee5ng k\u00edn.<\/li><li>\u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n cho nh\u1eefng tr\u1ebb c\u00f3 t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh c\u00f3 t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng r\u1ea5t cao v\u00e0 hi\u1ec7n nay \u0111\u00e3 tr\u1edf th\u00e0nh \u0111i\u1ec1u tr\u1ecb ti\u00eau chu\u1ea9n.<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Ph\u00e2n lo\u1ea1i ch\u1ea5n th\u01b0\u01a1ng gan<\/strong><\/p>\n\n\n\n<p>Ph\u00e2n \u0111\u1ed9 ch\u1ea5n th\u01b0\u01a1ng gan theo AAST<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>\u0110\u1ed9 I<\/strong>                   <\/td><td>T\u1ee5 m\u00e1u d\u01b0\u1edbi bao nh\u1ecf h\u01a1n 10% di\u1ec7n t\u00edch b\u1ec1 m\u1eb7t <br>R\u00e1ch bao gan,v\u1ee1 d\u01b0\u1edbi 1cm b\u1ec1 s\u00e2u<\/td><\/tr><tr><td><strong>\u0110\u1ed9 II<\/strong><\/td><td>T\u1ee5 m\u00e1u d\u01b0\u1edbi bao t\u1eeb 10% -50% di\u1ec7n t\u00edch b\u1ec1 m\u1eb7t hay trong nhu m\u00f4 <br>T\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 s\u00e2u 1-3 cm, chi\u1ec1u d\u00e0i nh\u1ecf h\u01a1n 10cm<\/td><\/tr><tr><td><strong>\u0110\u1ed9 III<\/strong>    <\/td><td>T\u1ee5 m\u00e1u d\u01b0\u1edbi bao l\u1edbn h\u01a1n 50% di\u1ec7n t\u00edch b\u1ec1 m\u1eb7t, t\u1ee5 m\u00e1u trong nhu m\u00f4 c\u00f3 k\u00edch th\u01b0\u1edbc l\u1edbn h\u01a1n 10cm <br>V\u1ee1 s\u00e2u h\u01a1n 3cm<\/td><\/tr><tr><td><strong>\u0110\u1ed9 IV<\/strong>                       <\/td><td>T\u1ed5n th\u01b0\u01a1ng nhu m\u00f4, v\u1ee1 25-75% th\u00f9y gan <br>V\u1ee1 t\u1eeb 1-3 h\u1ea1 ph\u00e2n th\u00f9y trong m\u1ed9t th\u00f9y gan<\/td><\/tr><tr><td><strong>\u0110\u1ed9 V<\/strong> <strong>&nbsp;<\/strong><\/td><td>T\u1ed5n th\u01b0\u01a1ng nhu m\u00f4, th\u00f9y gan v\u1ee1 l\u1edbn h\u01a1n 75%, h\u01a1n 3 h\u1ea1 ph\u00e2n th\u00f9y trong m\u1ed9t th\u00f9y gan <br>T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u ch\u00ednh c\u1ee7a gan hay c\u00e1c m\u1ea1ch m\u00e1u l\u00e2n c\u1eadn gan<\/td><\/tr><tr><td><strong>\u0110\u1ed9 VI<\/strong><\/td><td>Gan \u0111\u1ee9t kh\u1ecfi d\u00e2y ch\u1eb1ng treo gan v\u00e0 cu\u1ed1ng gan<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Ch\u1ea9n \u0111o\u00e1n<\/strong><\/p>\n\n\n\n<ul><li>C\u01a1 ch\u1ebf, th\u1eddi \u0111i\u1ec3m ch\u1ea5n th\u01b0\u01a1ng, ph\u01b0\u01a1ng ti\u1ec7n g\u00e2y ch\u1ea5n th\u01b0\u01a1ng.<\/li><li>Tri\u1ec7u ch\u1ee9ng x\u1ea3y ra sau khi b\u1ecb ch\u1ea5n th\u01b0\u01a1ng (\u0111au b\u1ee5ng, n\u00f4n,ch\u00f3ng m\u1eb7t\u2026).<\/li><li>S\u01a1 c\u1ee9u ban \u0111\u1ea7u t\u1ea1i hi\u1ec7n tr\u01b0\u1eddng.<\/li><li>Ti\u1ec1n c\u0103n: b\u1ec7nh n\u1ec1n, d\u1ecb \u1ee9ng, ngo\u1ea1i khoa<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>Kh\u00e1m l\u00e2m s\u00e0ng<\/strong><\/p>\n\n\n\n<ul><li>D\u1ea5u hi\u1ec7u sinh t\u1ed3n, c\u00f3 th\u1ec3 s\u1ed1c m\u1ea5t m\u00e1u<\/li><li>V\u1ebft b\u1ea7m, t\u1ee5 m\u00e1u, tr\u1ea7y x\u01b0\u1edbc, l\u1ed7 v\u1ebft th\u01b0\u01a1ng, b\u1ee5ng tr\u01b0\u1edbng.<\/li><li>Ch\u00fa \u00fd kh\u00f4ng b\u1ecf s\u00f3t ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u v\u00e0 ng\u1ef1c \u0111i c\u00f9ng<\/li><\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><strong>M\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m c\u1ea7n l\u00e0m?<\/strong><\/p>\n\n\n\n<ul><li>M\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m m\u00e1u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng m\u1ea5t m\u00e1u, c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111i k\u00e8m.<\/li><li>Si\u00eau \u00e2m b\u1ee5ng.<\/li><li>X quang ng\u1ef1c, b\u1ee5ng khi nghi ng\u1edd hay c\u1ea7n lo\u1ea1i tr\u1eeb c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c \u0111i k\u00e8m<\/li><li>Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT-scan b\u1ee5ng): khi nghi ng\u1edd t\u1ed5n th\u01b0\u01a1ng t\u1ea1ng tr\u00ean l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng kh\u00e1c. Th\u1ef1c hi\u1ec7n khi t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh. (h\u00ecnh 1)<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" width=\"712\" height=\"851\" src=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/08\/chan-thuong-gan-1.jpg\" alt=\"\" class=\"wp-image-802\" srcset=\"http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/08\/chan-thuong-gan-1.jpg 712w, http:\/\/phauthuatnhi.vn\/vi\/wp-content\/uploads\/2021\/08\/chan-thuong-gan-1-251x300.jpg 251w\" sizes=\"(max-width: 712px) 100vw, 712px\" \/><figcaption><strong>H\u00ecnh 1: Ph\u00e2n lo\u1ea1i ch\u1ea5n th\u01b0\u01a1ng gan tr\u00ean CTscan b\u1ee5ng c\u1ea3n quang.<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n<p class=\"has-medium-font-size\"><strong>\u0110i\u1ec1u tr\u1ecb<\/strong><\/p>\n\n\n\n<p><strong>Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb chung<\/strong><strong><\/strong><\/p>\n\n\n\n<ul><li>C\u1ea5p c\u1ee9u ngay t\u00ecnh tr\u1ea1ng nguy k\u1ecbch, ch\u1ed1ng s\u1ed1c m\u1ea5t m\u00e1u v\u00e0 s\u1ed1c do \u0111au n\u1ebfu c\u00f3<\/li><li>Kh\u00e1m to\u00e0n di\u1ec7n v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c t\u1ed5n th\u01b0\u01a1ng<\/li><li>\u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u theo nguy\u00ean nh\u00e2n (gan)<\/li><li>\u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3: gi\u1ea3m \u0111au v\u00e0 \u0103n \u0111\u01b0\u1eddng mi\u1ec7ng khi t\u00ecnh tr\u1ea1ng \u1ed5n \u0111\u1ecbnh, kh\u00e1ng sinh khi c\u00f3 nhi\u1ec5m tr\u00f9ng<\/li><\/ul>\n\n\n\n<p><strong>Ch\u1ec9 \u0111\u1ecbnh m\u1ed5 b\u1ee5ng th\u00e1m s\u00e1t (n\u1ed9i soi ho\u1eb7c m\u1ed5 m\u1edf)<\/strong><\/p>\n\n\n\n<ul><li>Nghi ng\u1edd c\u00f3 v\u1ebft th\u01b0\u01a1ng th\u1ea5u b\u1ee5ng.<\/li><li>Xu\u1ea5t huy\u1ebft trong \u1ed5 b\u1ee5ng sau khi truy\u1ec1n m\u00e1u &gt; 40ml\/kg m\u00e0 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh hay ch\u1ec9 s\u1ed1 Hct trong m\u00e1u &lt; 25%.<\/li><li>H\u01a1i t\u1ef1 do trong \u1ed5 b\u1ee5ng.<\/li><li>Nghi ng\u1edd c\u00f3 th\u1ee7ng t\u1ea1ng r\u1ed7ng hay vi\u00eam ph\u00fac m\u1ea1c.<\/li><li>Ch\u1ecdc d\u1ecbch \u1ed5 b\u1ee5ng ra: d\u1ecbch m\u1eadt, d\u1ecbch \u0111\u1ee5c, n\u01b0\u1edbc ti\u1ec3u.<\/li><\/ul>\n\n\n\n<p><strong>\u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n<\/strong><\/p>\n\n\n\n<p>H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n:<\/p>\n\n\n\n<ul><li>Chia c\u00e1c t\u1ed5n th\u01b0\u01a1ng do ch\u1ea5n th\u01b0\u01a1ng gan th\u00e0nh nh\u1eb9 (\u0111\u1ed9 I, II), v\u1eeba (\u0111\u1ed9 III) v\u00e0 n\u1eb7ng (\u0111\u1ed9 IV, V, VI).<\/li><li>C\u00e1c t\u1ed5n th\u01b0\u01a1ng AAST c\u1ea5p \u0111\u1ed9 th\u1ea5p (th\u01b0\u1eddng l\u00e0 c\u1ea5p I-III) \u0111\u01b0\u1ee3c coi l\u00e0 nh\u1eb9 ho\u1eb7c trung b\u00ecnh v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng b\u1ea3o t\u1ed3n.<\/li><\/ul>\n\n\n\n<p><strong>\u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/strong><\/p>\n\n\n\n<ul><li>Kh\u00e2u gan v\u1ee1 ho\u1eb7c m\u1ea1ch m\u00e1u t\u1ed5n th\u01b0\u01a1ng<\/li><li>C\u1eaft gan v\u1ee1<\/li><li>Gh\u00e9p gan khi v\u1ee1 ph\u1ee9c t\u1ea1p kh\u00f4ng th\u1ec3 kh\u00e2u c\u1ea7m m\u00e1u hay c\u1eaft gan<\/li><\/ul>\n\n\n\n<p><strong><em>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/em><\/strong><\/p>\n\n\n\n<ul><li>American College of Surgeons. Advanced trauma life support for doctors (ATLS) student manual. 8th ed. 2008.<\/li><li>Federico Coccolini.,\u00a0et al. \u201cWorld Journal of Emergency Surgery\u201d,\u00a0volume\u00a011, Article\u00a0number:\u00a050\u00a0(2016).<\/li><li>Margherita Trinci., et al. \u201cImaging Trauma and Polytrauma in Pediatric Patients\u201d\u00a0pp 65-100.<\/li><li>Stylianos S., Pear R.H (2012). \u201cAbdominal Trauma\u201d Pediatric Surgery, 7th edi, pp. 289- 309<\/li><li>The American Association for the Surgery of Trauma (2017). \u201cInjury Scoring Scale \u2013 A Resource for Trauma Care Professionals\u201d.<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<div class=\"mh-excerpt\"><p>\u0110\u1ea1i c\u01b0\u01a1ng B\u1ee5ng l\u00e0 m\u1ed9t trong ba n\u01a1i th\u01b0\u1eddng b\u1ecb t\u1ed5n th\u01b0\u01a1ng \u1edf tr\u1ebb em, sau \u0111\u1ea7u v\u00e0 tay ch\u00e2n, c\u0169ng l\u00e0 n\u01a1i d\u1ec5 b\u1ecb b\u1ecf s\u00f3t nh\u1eefng th\u01b0\u01a1ng t\u1ed5n g\u00e2y t\u1eed vong trong ch\u1ea5n <a class=\"mh-excerpt-more\" href=\"http:\/\/phauthuatnhi.vn\/vi\/cacloaibenh\/chan-thuong-gan-o-tre-em\/\" title=\"Ch\u1ea5n th\u01b0\u01a1ng gan \u1edf tr\u1ebb em\">[&#8230;]<\/a><\/p>\n<\/div>","protected":false},"author":4,"featured_media":806,"comment_status":"open","ping_status":"open","sticky":false,"template":"template-full.php","format":"standard","meta":[],"categories":[4,16],"tags":[],"_links":{"self":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/801"}],"collection":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/comments?post=801"}],"version-history":[{"count":7,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/801\/revisions"}],"predecessor-version":[{"id":810,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/posts\/801\/revisions\/810"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/media\/806"}],"wp:attachment":[{"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/media?parent=801"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/categories?post=801"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/phauthuatnhi.vn\/vi\/wp-json\/wp\/v2\/tags?post=801"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}