xuat huyet tieu hoa tren - bsck2 dinh quang tam
TRANSCRIPT
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7/23/2019 Xuat Huyet Tieu Hoa Tren - BSCK2 Dinh Quang Tam
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Bs. Ck2. inh Quan Tm
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Chy mu trong lng ng tiuha do tnthngtthcqun,
d dy, t trng n pha trngc Treit.
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Lot t trng: 24%
Vim d dy cp: 20% Lot d dy: 15% Dn tnhmchthcqun: 14% Vim thcqun: 6% Hichng Mallory_Weiss : 5% Cc nguyn nhn khc: 10%
Khng xc nh: 6%
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Nh Trung bnh NngLng mu mt < 500ml 500-1000ml > 1000ml
Tri gic Tnh, bnhthng
nim hngnht,mtmi
Btrt, hthong, vt v
Mch < 90l/p 90-120l/p > 120l/p
Huyt p tm thu > 90mmHg 80 - 90mmHg < 80mmHg
Hct > 30% 20 - 30% < 20%
Slnghngcu > 3triu 2 - 3 triu < 2triu
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nnhbnh nhn.
Xc inhv tr, nguyn nhn xuthuyt.
nh gi mcnng. X trcpcu
iutrbinchng, nh gi nguy cxut
huyt ti pht.
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Tip xc BN
Xc nh c XHTH: i mu, tiu phn en, tiu mu.. nh gi mc: nh, trung bnh, nng.
X tr banu
Lpngtruyn: 1-2 ngtruyn, CVP t sonde mid dy
iutr Ni soi chnon v iutr Cc thuc: Antacid, cchbm Proton, Octreotide
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iutrni khoa:Thuc khng thth H2.Thuccchbm proton.
Ni soi chnon v iutr:
nh gi tnh trngchy mu.Phng php cm mu:
Chch Adrenaline, Polidocanol 1 -2%, Absolute Ethanol Laser YAG,ng mu bng vi sng, tnhit.
Kpmch mu (Clip). iutrngoi khoa:Khu cm mu lot, mrng mn v km ct DTK X.Ct bn phnd dy.
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Tn bitdc: Nexium, Esomarks,... 40mg/l
Cch dng: Tn cng:
Bolus TM: 80mg (2ng).
TTM: 8mg/1h/72h pha 5ng vo NaCl 9%0 thnh25ml, bm tim in 1ml/gi.
Duy tr: Vin 40mg, 1 vin/ln/ngy/ 27 ngy.
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angchy mu I a chy mu phun thnh vi I b chy mu rr
Chy mu gny II a thymch mu II b cn cc mu ng
II c c chm khc mu Khng c chy mu
III khng thyduhiuchy mu
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Ni soi: chch x, tht dy thun, t stent
Thuc co mch.
t sonde Blakemore.
Phuthuttritmch Sugiura, PT to Shunt.
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Tc dng: + Gimlng mu htng 25% +Gimlng mu n gan 25% + Gim p lctrn gan bt 10-15% + Gim p lc trong tnh
mchthcquntrng 35% + Thuc khng lmthay imch, huyt p v cung lng tim.
Bitdc: Sandostatin ... 0,1 mg/1ml/ng
Cch dng:
Tim TM: 0,1 mg.
TTM: 0,025/gi/5 ngy. Pha 06ng vo NaCl9%othnh 24 ml, bm tim in 1ml/gi.
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Loi A
(Nguy cthp) Loi B(nguy c trung bnh) Loi C(Nguy c cao)Bng bng 0 Nh Nhiu
Hn m gan 0 1_2 3_4Albumin/mu(mg%) >3.5 3_3.5
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Xc nhchiu di: cnhmi di tai (T)hm c + 10 cm
Bm bng: bng DD -50ml + 150 bng TQ
60ml
Ko cng:
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Mi 30p bmrad dy xem cn chy khng.Cn : bm bng DD 250ml.Sau vnchybm thm bng TQ 70 ml
Ngy u, mi 6h xhthi trong bng thcqun 30ml nhngvnging thng tich:Nuchy mu li: bm bng thcqunnh lcu.
Nu khng chy mu: thm 24h m khng chyth x bng d dy, rtng thng. Nu qua ngy2: mi 4h x bng thcqun 30ml
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Khi xuthuytmcnng:
1/3 khilngtun hon l mu.
2/3 khilngtun hon l dd ngtrngTruynn khi tri gic, mch, HAnnh,Hct>20%,HC>2triu.
Khi cha c mu kpthi thay bngGenlafudin.
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Thng s T vong (%)T vong chung 5 - 8
Theo tui> 60
> 8010 - 15
25 - 30
Huyt p tm thu lc vo vin80 - 90mmHg
< 80mmHg12 - 15
30 - 35
Dch ra thng d dy lc vo vinNh b c phMu ti
6 - 10
18 - 20
Truyn mu> 10 nv (1 nv =500ml) 28 - 34
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