Xuat Huyet Tieu Hoa Tren - BSCK2 Dinh Quang Tam

7/23/2019 Xuat Huyet Tieu Hoa Tren - BSCK2 Dinh Quang Tam

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Bs. Ck2. inh Quan Tm


2/25

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.


6/25

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


7/25

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.


9/25

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


10/25

Ni soi: chch x, tht dy thun, t stent

Thuc co mch.

t sonde Blakemore.

Phuthuttritmch Sugiura, PT to Shunt.


11/25

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.


12/25

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:


15/25

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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Xuat Huyet Tieu Hoa Tren - BSCK2 Dinh Quang Tam

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