{"id":134341,"date":"2025-08-22T16:26:35","date_gmt":"2025-08-22T09:26:35","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=134341"},"modified":"2025-08-27T19:04:06","modified_gmt":"2025-08-27T12:04:06","slug":"tao-bon-o-tre-em-va-vi-thanh-nien-danh-gia-va-dieu-tri","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/tao-bon-o-tre-em-va-vi-thanh-nien-danh-gia-va-dieu-tri\/","title":{"rendered":"T\u00e1o B\u00f3n \u1ede Tr\u1ebb Em V\u00e0 V\u1ecb Th\u00e0nh Ni\u00ean: \u0110\u00e1nh Gi\u00e1 V\u00e0 \u0110i\u1ec1u Tr\u1ecb"},"content":{"rendered":"<p><strong>T\u00e1o b\u00f3n<\/strong> \u1edf tr\u1ebb em th\u01b0\u1eddng l\u00e0 t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n th\u1ef1c th\u1ec3. C\u00e1c nguy\u00ean nh\u00e2n th\u1ef1c th\u1ec3 g\u00e2y t\u00e1o b\u00f3n \u1edf tr\u1ebb em bao g\u1ed3m b\u1ec7nh Hirschsprung, x\u01a1 nang v\u00e0 d\u1ecb t\u1eadt c\u1ed9t s\u1ed1ng th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u c\u1ea5p \u0111\u1ecf. B\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng b\u1eb1ng ti\u00eau chu\u1ea9n Rome IV. M\u1ee5c ti\u00eau \u0111\u1ea7u ti\u00ean trong qu\u1ea3n l\u00fd t\u00e1o b\u00f3n l\u00e0 l\u00e0m s\u1ea1ch ph\u00e2n (fecal impaction), v\u00e0 sau \u0111\u00f3 \u0111i\u1ec1u tr\u1ecb duy tr\u00ec \u0111\u1ec3 ng\u0103n ng\u1eeba t\u00e1i ph\u00e1t. Polyethylene glycol l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay trong t\u00e1o b\u00f3n. L\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb th\u1ee9 hai bao g\u1ed3m lactulose v\u00e0 thu\u1ed1c x\u1ed5. T\u0103ng \u0103n ch\u1ea5t x\u01a1 v\u00e0 u\u1ed1ng nhi\u1ec1u n\u01b0\u1edbc c\u0169ng nh\u01b0 men probiotics kh\u00f4ng c\u00f3 l\u1ee3i \u00edch trong \u0111i\u1ec1u tr\u1ecb t\u00e1o b\u00f3n. T\u00e1i kh\u00e1m th\u01b0\u1eddng xuy\u00ean v\u00e0 kh\u00e1m t\u00e2m l\u00fd c\u00f3 th\u1ec3 h\u1eefu \u00edch trong \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb. B\u00e1c s\u0129 l\u00e2m s\u00e0ng n\u00ean gi\u00e1o d\u1ee5c ng\u01b0\u1eddi ch\u0103m s\u00f3c v\u1ec1 di\u1ec5n bi\u1ebfn m\u1ea1n t\u00ednh c\u1ee7a t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng, th\u01b0\u1eddng xuy\u00ean t\u00e1i ph\u00e1t v\u00e0 c\u00f3 th\u1ec3 c\u1ea7n \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i. B\u00e1c s\u0129 l\u00e2m s\u00e0ng n\u00ean gi\u1ea3i th\u00edch nh\u1eefng th\u00e1ch th\u1ee9c c\u1ee5 th\u1ec3 v\u00e0 t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c c\u1ee7a t\u00e1o b\u00f3n l\u00ean ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a tr\u1ebb. Chuy\u00ean khoa ti\u00eau h\u00f3a nhi \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o khi lo l\u1eafng v\u1ec1 c\u00e1c nguy\u00ean nh\u00e2n th\u1ef1c th\u1ec3 ho\u1eb7c t\u00e1o b\u00f3n dai d\u1eb3ng d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ee7.<\/p>\n<p>T\u00e1o b\u00f3n &#8211; \u1edf tr\u1ebb em v\u00e0 tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 ch\u1eadm \u0111i ngo\u00e0i ho\u1eb7c \u0111i ngo\u00e0i kh\u00f4ng th\u01b0\u1eddng xuy\u00ean ph\u00e2n c\u1ee9ng, \u0111au v\u00e0 ph\u1ea3i r\u1eb7n nhi\u1ec1u. T\u1ef7 l\u1ec7 m\u1eafc t\u00e1o b\u00f3n \u1edf tr\u1ebb em v\u00e0 tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean \u01b0\u1edbc t\u00ednh 30% tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. T\u00e1o b\u00f3n \u1edf tr\u1ebb em chi\u1ebfm 3% c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ebfn ph\u00f2ng kh\u00e1m s\u1ee9c kh\u1ecfe ban \u0111\u1ea7u v\u00e0 l\u00ean \u0111\u1ebfn 25% c\u00e1c tr\u01b0\u1eddng h\u1ee3p cho kh\u00e1m h\u1ed9i ch\u1ea9n chuy\u00ean khoa ti\u00eau h\u00f3a nhi. T\u00e1o b\u00f3n m\u1ea1n t\u00ednh c\u00f3 th\u1ec3 g\u00e2y nh\u1eefng t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a tr\u1ebb.<\/p>\n<h3>Ki\u1ec3u h\u00ecnh \u0111i ph\u00e2n b\u00ecnh th\u01b0\u1eddng<\/h3>\n<p>S\u1ed1 l\u1ea7n \u0111i ph\u00e2n h\u00e0ng ng\u00e0y gi\u1ea3m theo \u0111\u1ed9 tu\u1ed5i c\u1ee7a tr\u1ebb, trung b\u00ecnh kho\u1ea3ng 4 l\u1ea7n\/ng\u00e0y \u1edf tr\u1ebb nh\u0169 nhi, 2 l\u1ea7n\/ng\u00e0y \u1edf tr\u1ebb 2 tu\u1ed5i, v\u00e0 1 l\u1ea7n\/ng\u00e0y sau 4 tu\u1ed5i. Tr\u1ebb nh\u0169 nhi b\u00fa m\u1eb9 ho\u00e0n to\u00e0n l\u00e0 ngo\u1ea1i l\u1ec7 v\u00ec kho\u1ea3ng c\u00e1ch gi\u1eefa c\u00e1c l\u1ea7n \u0111i ph\u00e2n c\u00f3 th\u1ec3 l\u00e0 v\u00e0i ng\u00e0y.<\/p>\n<h3>Ph\u00e2n lo\u1ea1i<\/h3>\n<p>T\u00e1o b\u00f3n ch\u1ee9c n\u0103ng (kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n th\u1ef1c th\u1ec3) l\u00e0 d\u1ea1ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong t\u00e1o b\u00f3n \u1edf tr\u1ebb em v\u00e0 tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean, chi\u1ebfm 95% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. Ch\u1ec9 5% c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u00e1o b\u00f3n \u1edf tr\u1ebb em v\u00e0 tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean c\u00f3 nguy\u00ean nh\u00e2n th\u1ef1c th\u1ec3 nh\u01b0 b\u1ec7nh Hirschsprung, x\u01a1 nang, h\u1ed9i ch\u1ee9ng Down, d\u1ecb t\u1eadt kh\u00f4ng h\u1eadu m\u00f4n, b\u1ec7nh l\u00fd th\u1ea7n kinh c\u01a1, d\u1ecb t\u1eadt t\u1ee7y s\u1ed1ng v\u00e0 b\u1ec7nh celiac. C\u00e1c thu\u1ed1c nh\u1ea5t \u0111\u1ecbnh nh\u01b0 opiates, kh\u00e1ng acid v\u00e0 kh\u00e1ng cholinergic c\u0169ng c\u00f3 th\u1ec3 g\u00e2y t\u00e1o b\u00f3n.<\/p>\n<p>T\u00e1o b\u00f3n ch\u1ee9c n\u0103ng \u0111\u01b0\u1ee3c ph\u00e2n trong nh\u00f3m b\u1ec7nh l\u00fd ti\u00eau ho\u00e1 ch\u1ee9c n\u0103ng kh\u00f4ng th\u1ec3 gi\u1ea3i th\u00edch b\u1eb1ng c\u00e1c b\u1ec7nh l\u00fd c\u1ea5u tr\u00fac ho\u1eb7c b\u1ea5t th\u01b0\u1eddng sinh ho\u00e1. C\u00e1c b\u1ec7nh l\u00fd ti\u00eau ho\u00e1 ch\u1ee9c n\u0103ng kh\u00e1c \u1edf tr\u1ebb em c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn t\u00e1o b\u00f3n l\u00e0 \u0111\u1ea1i ti\u1ec7n kh\u00f4ng t\u1ef1 ch\u1ee7 (dyschezia) \u1edf tr\u1ebb nh\u0169 nhi v\u00e0 nonretentive fecal incontinence. \u0110\u1ea1i ti\u1ec7n kh\u00f4ng t\u1ef1 ch\u1ee7 tr\u1ebb nh\u0169 nhi g\u1eb7p \u1edf tr\u1ebb d\u01b0\u1edbi 9 th\u00e1ng c\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ed1ng t\u00e1o b\u00f3n, bao g\u1ed3m r\u1eb7n, kh\u00f3c v\u00e0 \u0111\u1ecf m\u1eb7t tho\u1ea3ng qua, nh\u01b0ng ph\u00e2n th\u01b0\u1eddng m\u1ec1m. C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng t\u1ef1 kh\u1ecfi v\u00e0 n\u00f3 th\u01b0\u1eddng do m\u1ea5t ph\u1ed1i h\u1ee3p c\u01a1 th\u1eaft h\u1eadu m\u00f4n. Nonretentive fecal incontinence kh\u00e1c v\u1edbi t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng \u1edf s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a \u0111i ph\u00e2n kh\u00f4ng t\u1ef1 ch\u1ee7 m\u00e0 kh\u00f4ng c\u00f3 \u1ee9 ph\u00e2n, s\u1ed1 l\u1ea7n \u0111i ph\u00e2n b\u00ecnh th\u01b0\u1eddng v\u00e0 th\u1eddi gian transit \u0111\u1ea1i tr\u00e0ng b\u00ecnh th\u01b0\u1eddng \u1edf tr\u1ebb 4 \u0111\u1ebfn 18 tu\u1ed5i. C\u00e1c v\u1ea5n \u0111\u1ec1 t\u00e2m th\u1ea7n n\u1eb7ng ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y \u1edf tr\u1ebb nonretentive fecal incontinence. \u0110\u1ea1i ti\u1ec7n kh\u00f4ng t\u1ef1 ch\u1ee7 (Encopresis) kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn trong ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n Rome IV; tuy nhi\u00ean, n\u00f3 n\u1eb1m trong DSM V, l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u00f3 th\u1ec3 g\u1eb7p ho\u1eb7c kh\u00f4ng g\u1eb7p t\u00ecnh tr\u1ea1ng \u1ee9 ph\u00e2n. \u0110\u1ea1i ti\u1ec7n kh\u00f4ng t\u1ef1 ch\u1ee7 l\u00e0 t\u00ecnh tr\u1ea1ng \u0111i ph\u00e2n nhi\u1ec1u l\u1ea7n \u1edf nh\u1eefng n\u01a1i kh\u00f4ng th\u00edch h\u1ee3p (ra qu\u1ea7n \u00e1o ho\u1eb7c s\u00e0n nh\u00e0), m\u1ed9t ho\u1eb7c nhi\u1ec1u l\u1ea7n trong th\u00e1ng.<\/p>\n<h2>KHUY\u1ebeN C\u00c1O TRONG TH\u1ef0C H\u00c0NH L\u00c2M S\u00c0NG<\/h2>\n<ul>\n<li>T\u00e1o b\u00f3n ch\u1ee9c n\u0103ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o b\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1edd \u0111\u1ecf.<\/li>\n<li>Th\u0103m h\u1eadu m\u00f4n v\u00e0 ch\u1ee5p x-quang kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u01b0\u1eddng quy \u1edf tr\u1ebb nghi ng\u1edd t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng.<\/li>\n<li>T\u0103ng \u0103n ch\u1ea5t x\u01a1 v\u00e0 u\u1ed1ng nhi\u1ec1u n\u01b0\u1edbc kh\u00f4ng c\u1ea3i thi\u1ec7n t\u00e1o b\u00f3n \u1edf tr\u1ebb em.<\/li>\n<li>Men vi sinh kh\u00f4ng c\u00f3 l\u1ee3i \u00edch trong \u0111i\u1ec1u tr\u1ecb t\u00e1o b\u00f3n \u1edf tr\u1ebb em.<\/li>\n<li>Cho tr\u1ebb t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng kh\u00e1m chuy\u00ean khoa t\u00e2m b\u1ec7nh c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n m\u1ed9t v\u00e0i k\u1ebft c\u1ee5c t\u00e1o b\u00f3n.<\/li>\n<li>Polyethylene glycol (Miralax) l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay trong t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng \u1edf tr\u1ebb em.<\/li>\n<\/ul>\n<h3>Nguy\u00ean nh\u00e2n v\u00e0 Sinh l\u00fd b\u1ec7nh<\/h3>\n<p>T\u00e1o b\u00f3n th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u khi tr\u1ebb chuy\u1ec3n sang \u0103n d\u1eb7m, t\u1eadp \u0111i v\u1ec7 sinh v\u00e0 b\u1eaft \u0111\u1ea7u \u0111i h\u1ecdc. Tu\u1ed5i trung b\u00ecnh kh\u1edfi ph\u00e1t t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng l\u00e0 2.3 tu\u1ed5i. Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng \u1edf nam v\u00e0 n\u1eef.<\/p>\n<p>T\u00e1o b\u00f3n g\u00e2y \u0111au khi \u0111i ti\u00eau, c\u00f3 th\u1ec3 l\u00e0m cho \u0111\u1ee9a tr\u1ebb nh\u1ecbn \u0111i ph\u00e2n. Nh\u1ecbn \u0111i ngo\u00e0i l\u00e0m t\u0103ng h\u1ea5p thu n\u01b0\u1edbc \u1edf \u0111\u1ea1i tr\u00e0ng, l\u00e0m ph\u00e2n c\u1ee9ng h\u01a1n v\u00e0 kh\u00f3 \u0111i h\u01a1n. B\u1ed1 m\u1eb9 th\u01b0\u1eddng b\u1ed1i r\u1ed1i v\u1edbi h\u00e0nh vi n\u00e0y v\u1edbi r\u1eb7n \u0111i \u0111\u1ea1i ti\u1ec7n. Theo th\u1eddi gian, \u1edf ph\u00e2n l\u00e0m gi\u00e3n tr\u1ef1c tr\u00e0ng, g\u00e2y gi\u1ea3m c\u1ea3m gi\u00e1c mu\u1ed1n \u0111i \u0111\u1ea1i ti\u1ec7n. T\u00edch t\u1ee5 ph\u00e2n trong tr\u1ef1c tr\u00e0ng l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng l\u00e0m tr\u1ed1ng d\u1ea1 d\u00e0y, g\u00e2y ch\u01b0\u1edbng b\u1ee5ng, \u0111au b\u1ee5ng, bu\u1ed3n n\u00f4n v\u00e0 ch\u00e1n \u0103n.<\/p>\n<p>B\u1ea2NG 1. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng \u1edf tr\u1ebb em theo Rome IV<\/p>\n<table width=\"602\">\n<tbody>\n<tr>\n<td width=\"602\">\u25cf\u00a0\u00a0\u00a0\u00a0\u00a0 \u2265 2 trong c\u00e1c ti\u00eau chu\u1ea9n sau, xu\u1ea5t hi\u1ec7n \u00edt nh\u1ea5t 1 l\u1ea7n\/tu\u1ea7n trong \u00edt nh\u1ea5t 1 th\u00e1ng:<\/p>\n<p>\u25cf\u00a0\u00a0\u00a0\u00a0\u00a0 \u2264 2 \u0111i ti\u00eau trong tu\u1ea7n \u1edf tr\u1ebb \u2265 4 tu\u1ed5i<\/p>\n<p>\u25cf\u00a0\u00a0\u00a0\u00a0\u00a0 \u2265 1 l\u1ea7n \u0111i ti\u00eau kh\u00f4ng t\u1ef1 ch\u1ee7 trong tu\u1ea7n<\/p>\n<p>\u25cf\u00a0\u00a0\u00a0\u00a0\u00a0 Ti\u1ec1n s\u1eed nh\u1ecbn \u0111i ngo\u00e0i (gi\u1eef ph\u00e2n qu\u00e1 m\u1ee9c) ho\u1eb7c t\u01b0 th\u1ebf retentive<\/p>\n<p>\u25cf\u00a0\u00a0\u00a0\u00a0\u00a0 Ti\u1ec1n s\u1eed \u0111i ngo\u00e0i ph\u00e2n c\u1ee9ng ho\u1eb7c \u0111au<\/p>\n<p>\u25cf\u00a0\u00a0\u00a0\u00a0\u00a0 S\u1ef1 hi\u1ec7n di\u1ec7n kh\u1ed1i ph\u00e2n l\u1edbn trong tr\u1ef1c tr\u00e0ng<\/p>\n<p>\u25cf\u00a0\u00a0\u00a0\u00a0\u00a0 \u0110\u01b0\u1eddng k\u00ednh ph\u00e2n to g\u00e2y t\u1eafc b\u1ed3n c\u1ea7u<\/p>\n<p>\u25cf\u00a0\u00a0\u00a0\u00a0\u00a0 Sau khi \u0111\u00e1nh gi\u00e1, tri\u1ec7u ch\u1ee9ng kh\u00f4ng th\u1ec3 gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3>Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng<\/h3>\n<p>T\u00e1o b\u00f3n ch\u1ee9c n\u0103ng l\u00e0 ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng d\u1ef1a v\u00e0o ti\u00eau chu\u1ea9n Rome IV. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n Rome IV d\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng, v\u00e0 kh\u00f4ng c\u1ea7n x\u00e9t nghi\u1ec7m th\u00eam \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o. H\u1ecfi b\u1ec7nh v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng th\u01b0\u1eddng \u0111\u1ee7 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng v\u00e0 n\u00ean lo\u1ea1i tr\u1eeb c\u00e1c d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o v\u00e0 nguy\u00ean nh\u00e2n th\u1ef1c th\u1ec3. Tri\u1ec7u ch\u1ee9ng nhi\u1ec5m tr\u00f9ng ti\u1ec3u c\u0169ng n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t trong b\u1ec7nh s\u1eed, ti\u1ec1n s\u1eed v\u00ec c\u00f3 kh\u1ea3 n\u0103ng li\u00ean quan \u0111\u1ebfn t\u00e1o b\u00f3n.<\/p>\n<p>Kh\u00f4ng c\u00f3 \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng h\u1ed7 tr\u1ee3 th\u0103m h\u1eadu m\u00f4n th\u01b0\u1eddng quy trong ch\u1ea9n \u0111o\u00e1n t\u00e1o b\u00f3n, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf tr\u1ebb tr\u00ean 1 tu\u1ed5i kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o. Th\u0103m h\u1eadu m\u00f4n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n khi ch\u1ea9n \u0111o\u00e1n t\u00e1o b\u00f3n kh\u00f4ng ch\u1eafc ch\u1eafn, \u0111\u1ec3 x\u00e1c nh\u1eadn \u0111i\u1ec1u tr\u1ecb th\u00e1o ph\u00e2n th\u00e0nh c\u00f4ng, ho\u1eb7c n\u1ebfu nghi ng\u1edd nguy\u00ean nh\u00e2n th\u1ef1c th\u1ec3.<\/p>\n<p>Ngo\u00e0i c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n (x\u00e9t nghi\u1ec7m m\u00e1u, xquang, ch\u1ee5p l\u01b0u th\u00f4ng \u0111\u1ea1i tr\u00e0ng v\u00e0 \u0111o manometry h\u1eadu m\u00f4n tr\u1ef1c tr\u00e0ng) kh\u00f4ng c\u1ea7n \u1edf tr\u1ebb t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng v\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o). Xquang b\u1ee5ng c\u00f3 gi\u00e1 tr\u1ecb h\u1ea1n ch\u1ebf trong ch\u1ea9n \u0111o\u00e1n t\u00e1o b\u00f3n. Xquang b\u1ee5ng n\u00ean d\u00e0nh cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng c\u1ee5 th\u1ec3, ch\u1ea9n \u0111o\u00e1n kh\u00f4ng ch\u1eafc ch\u1eafn, ho\u1eb7c \u0111\u00e1nh gi\u00e1 l\u1ea1i sau \u0111i\u1ec1u tr\u1ecb th\u1ee5t ph\u00e2n.<\/p>\n<h3>Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h3>\n<p>B\u1ec7nh Hirschsprung c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n ch\u1eadm ti\u00eau ph\u00e2n su (k\u00e9o d\u00e0i qu\u00e1 48 gi\u1edd sau sinh), t\u00e1o b\u00f3n trong v\u00e0i th\u00e1ng \u0111\u1ea7u \u0111\u1eddi, ch\u01b0\u1edbng b\u1ee5ng nhi\u1ec1u, v\u00e0 ch\u1eadm t\u0103ng c\u00e2n. T\u1ec9 l\u1ec7 m\u1eafc t\u00e1o b\u00f3n \u1edf tr\u1ebb x\u01a1 nang dao \u0111\u1ed9ng t\u1eeb 10% \u0111\u1ebfn 57% v\u00e0 n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh ho\u1eb7c t\u00e1o b\u00f3n k\u00e8m theo c\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c nh\u01b0 tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p v\u00e0 ch\u1eadm l\u1edbn. D\u1ecb \u1ee9ng \u0111\u1ea1m s\u1eefa b\u00f2 c\u00f3 th\u1ec3 g\u00e2y t\u00e1o b\u00f3n v\u00e0 c\u00f3 m\u00e1u trong ph\u00e2n. C\u00e1c y\u1ebfu t\u1ed1 t\u00e2m l\u00fd v\u00e0 h\u00e0nh vi c\u0169ng c\u00f3 th\u1ec3 g\u00e2y t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n t\u1ef1 k\u1ec9 v\u00e0 t\u0103ng \u0111\u1ed9ng gi\u1ea3m ch\u00fa \u00fd (ADHD).<\/p>\n<h3>\u0110i\u1ec1u tr\u1ecb<\/h3>\n<p>\u0110i\u1ec1u tr\u1ecb t\u00e1o b\u00f3n bao g\u1ed3m \u0111i\u1ec1u ch\u1ec9nh ch\u1ebf \u0111\u1ed9 \u0103n, can thi\u1ec7p h\u00e0nh vi, thu\u1ed1c v\u00e0 th\u1ee5t ph\u00e2n n\u1ebfu c\u1ea7n.<\/p>\n<h2>THAY \u0110\u1ed4I CH\u1ebe \u0110\u1ed8 \u0102N<\/h2>\n<p>Tr\u1ebb nh\u0169 nhi \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi n\u01b0\u1edbc \u00e9p ch\u1ee9a sorbitol (vd, t\u00e1o, m\u1eadn v\u00e0 l\u00ea), c\u00f3 th\u1ec3 t\u0103ng t\u1ea7n su\u1ea5t \u0111i ngo\u00e0i v\u00e0 n\u01b0\u1edbc trong ph\u00e2n. Li\u1ec1u khuy\u1ebfn c\u00e1o c\u1ee7a n\u01b0\u1edbc \u00e9p m\u1eadn cho tr\u1ebb d\u01b0\u1edbi 6 th\u00e1ng 1 \u0111\u1ebfn 3 mL\/kg, c\u00f3 th\u1ec3 pha lo\u00e3ng v\u1edbi 30-60 ml (1-2 oz) n\u01b0\u1edbc. Can thi\u1ec7p h\u00e0ng ng\u00e0y ch\u1ec9 n\u00ean l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay trong t\u00e1o b\u00f3n \u1edf tr\u1ebb nh\u0169 nhi.<\/p>\n<p>M\u1eb7c d\u00f9 \u00edt d\u1ecbch v\u00e0 ch\u1ea5t x\u01a1 c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n g\u00e2y t\u00e1o b\u00f3n, nh\u01b0ng t\u0103ng l\u01b0\u1ee3ng d\u1ecbch (s\u1eefa, n\u01b0\u1edbc, c\u00e1c lo\u1ea1i th\u1ee9c u\u1ed1ng kh\u00e1c) ho\u1eb7c ch\u1ea5t x\u01a1 tr\u00ean m\u1ee9c nhu c\u1ea7u khuy\u1ebfn c\u00e1o h\u00e0ng ng\u00e0y kh\u00f4ng gi\u00fap c\u1ea3i thi\u1ec7n t\u00e1o b\u00f3n \u1edf tr\u1ebb em. Khuy\u1ebfn c\u00e1o u\u1ed1ng n\u01b0\u1edbc 4 c\u1ed1c\/ng\u00e0y cho tr\u1ebb 1-3 tu\u1ed5i, 5 c\u1ed1c cho tr\u1ebb 4-8 tu\u1ed5i, v\u00e0 7-8 c\u1ed1c cho tr\u1ebb l\u1edbn h\u01a1n. Tr\u1ebb em v\u00e0 tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean \u0103n \u0111\u1ee7 ch\u1ea5t x\u01a1 t\u1eeb 5 kh\u1ea9u ph\u1ea7n (1 kh\u1ea9u ph\u1ea7n t\u01b0\u01a1ng \u0111\u01b0\u01a1ng 80-100g, 5 kh\u1ea9u ph\u1ea7n t\u01b0\u01a1ng \u0111\u01b0\u01a1ng 400g) tr\u00e1i c\u00e2y v\u00e0 rau c\u1ee7. Ch\u1ea5t x\u01a1 khuy\u1ebfn c\u00e1o h\u00e0ng ng\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u00ednh b\u1eb1ng c\u00e1ch c\u1ed9ng th\u00eam 5g v\u00e0o tu\u1ed5i c\u1ee7a tr\u1ebb t\u00ednh theo n\u0103m.<\/p>\n<p>Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng t\u0103ng ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t ho\u1eb7c d\u00f9ng men trong t\u00e1o b\u00f3n. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng h\u1ed7 tr\u1ee3 x\u00e9t nghi\u1ec7m d\u1ecb \u1ee9ng \u0111\u1ea1m s\u1eefa b\u00f2 cho tr\u1ebb b\u1ecb t\u00e1o b\u00f3n.<\/p>\n<h2>CAN THI\u1ec6P H\u00c0NH VI<\/h2>\n<p>Thang \u0111i\u1ec3m ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng th\u1ea5p h\u01a1n \u1edf tr\u1ebb t\u00e1o b\u00f3n m\u1ea1n t\u00ednh h\u01a1n l\u00e0 tr\u1ebb kh\u00f4ng b\u1ecb t\u00e1o b\u00f3n. Tr\u1ebb b\u1ecb t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng c\u00f3 th\u1ec3 x\u1ea5u h\u1ed5, b\u1ecb b\u1ea1n b\u00e8 xa l\u00e1nh, b\u1ecb b\u1eaft n\u1ea1t v\u00e0 \u0111i\u1ec1u tr\u1ecb th\u1ea5t b\u1ea1i nhi\u1ec1u l\u1ea7n. Tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng t\u0103ng nguy c\u01a1 tr\u1ea7m c\u1ea3m, lo \u00e2u, v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 x\u00e3 h\u1ed9i. B\u1eb1ng ch\u1ee9ng hi\u1ec7n t\u1ea1i kh\u00f4ng h\u1ed7 tr\u1ee3 cho vi\u1ec7c can thi\u1ec7p h\u00e0nh vi t\u00edch c\u1ef1c ho\u1eb7c biofeedback trong \u0111i\u1ec1u tr\u1ecb t\u00e1o b\u00f3n. Tuy nhi\u00ean, nh\u1eefng \u0111i\u1ec1u ch\u1ec9nh h\u00e0nh vi nh\u1ecf nh\u01b0 hu\u1ea5n luy\u1ec7n \u0111i v\u1ec7 sinh c\u00f3 c\u1ea5u tr\u00fac k\u1ebft h\u1ee3p v\u1edbi h\u1ec7 th\u1ed1ng khen th\u01b0\u1edfng, trong \u0111\u00f3 tr\u1ebb \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn \u0111i ti\u00eau sau m\u1ed7i b\u1eefa \u0103n, c\u00f3 th\u1ec3 gi\u00fap ng\u0103n ng\u1eeba t\u00e1i ph\u00e1t t\u00ecnh tr\u1ea1ng \u1ee9 ph\u00e2n.<\/p>\n<p>M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y vi\u1ec7c k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb y khoa v\u1edbi li\u1ec7u ph\u00e1p h\u00e0nh vi c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng s\u00f3n ph\u00e2n v\u00e0 c\u00e1c k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng kh\u00e1c. C\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng n\u00ean c\u00e2n nh\u1eafc vi\u1ec7c cho tr\u1ebb t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng \u0111\u1ebfn chuy\u00ean gia t\u00e2m l\u00fd tr\u1ebb em, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi th\u00f3i quen \u0111i ti\u00eau b\u00ecnh th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c kh\u00f4i ph\u1ee5c trong v\u00f2ng 3 th\u00e1ng k\u1ec3 t\u1eeb khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>C\u00e1c b\u00e1c s\u0129 c\u0169ng c\u1ea7n ghi nh\u1eadn nh\u1eefng t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c c\u00f3 th\u1ec3 x\u1ea3y ra c\u1ee7a t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng \u0111\u1ed1i v\u1edbi cha m\u1eb9 ho\u1eb7c ng\u01b0\u1eddi ch\u0103m s\u00f3c tr\u1ebb. Cha m\u1eb9 ch\u0103m s\u00f3c tr\u1ebb b\u1ecb t\u00e1o b\u00f3n th\u01b0\u1eddng b\u00e1o c\u00e1o r\u1eb1ng h\u1ecd c\u00f3 nh\u1eefng nhu c\u1ea7u ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng, bao g\u1ed3m ki\u1ebfn th\u1ee9c v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c, c\u1ea3m gi\u00e1c b\u1ecb c\u00f4 l\u1eadp, b\u1ecb \u0111\u1ed5 l\u1ed7i cho t\u00ecnh tr\u1ea1ng c\u1ee7a tr\u1ebb, ph\u1ea3i \u0111\u1ed1i m\u1eb7t v\u1edbi th\u1ea5t b\u1ea1i trong \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u1ea3m th\u1ea5y b\u1ecb xem nh\u1eb9 b\u1edfi c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng.<\/p>\n<h2>L\u00c0M S\u1ea0CH PH\u00c2N \u1ee8<\/h2>\n<p>\u1ede nh\u1eefng tr\u1ebb \u0111\u1ebfn kh\u00e1m v\u1edbi t\u00ecnh tr\u1ea1ng \u1ee9 ph\u00e2n, vi\u1ec7c lo\u1ea1i b\u1ecf kh\u1ed1i ph\u00e2n r\u1eafn trong \u0111\u1ea1i tr\u00e0ng l\u00e0 b\u01b0\u1edbc \u0111\u1ea7u ti\u00ean trong \u0111i\u1ec1u tr\u1ecb t\u00e1o b\u00f3n. \u1ee8 ph\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n d\u1ef1a tr\u00ean ti\u1ec1n s\u1eed s\u00f3n ph\u00e2n, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a kh\u1ed1i ph\u00e2n s\u1edd \u0111\u01b0\u1ee3c khi kh\u00e1m th\u0103m b\u1ee5ng, ho\u1eb7c ph\u00e1t hi\u1ec7n ph\u00e2n r\u1eafn trong tr\u1ef1c tr\u00e0ng gi\u00e3n khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh th\u0103m tr\u1ef1c tr\u00e0ng.<\/p>\n<p>Vi\u1ec7c l\u00e0m s\u1ea1ch ph\u00e2n \u1ee9 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng thu\u1ed1c \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c \u0111\u01b0\u1eddng tr\u1ef1c tr\u00e0ng. Polyethylene glycol l\u00e0 m\u1ed9t lo\u1ea1i polymer h\u1ea7u nh\u01b0 kh\u00f4ng \u0111\u01b0\u1ee3c h\u1ea5p thu qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a gi\u00fap gi\u1eef n\u01b0\u1edbc trong ru\u1ed9t v\u00e0 l\u00e0m m\u1ec1m ph\u00e2n. Polyethylene glycol \u0111\u01b0\u1ee3c xem l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay v\u00ec hi\u1ec7u qu\u1ea3 h\u01a1n c\u00e1c thu\u1ed1c kh\u00e1c trong c\u1ea3 giai \u0111o\u1ea1n l\u00e0m s\u1ea1ch ph\u00e2n \u1ee9 l\u1eabn duy tr\u00ec, \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t v\u00e0 \u00edt nguy c\u01a1 t\u00e1c d\u1ee5ng ph\u1ee5.<\/p>\n<p>Trong \u0111i\u1ec1u tr\u1ecb \u1ee9 ph\u00e2n, li\u1ec1u Polyethylene glycol l\u00e0 1-1.5 g\/kg\/ng\u00e0y, h\u00f2a tan trong 180-240 ml n\u01b0\u1edbc ho\u1eb7c n\u01b0\u1edbc tr\u00e1i c\u00e2y, u\u1ed1ng h\u00e0ng ng\u00e0y trong 2-6 ng\u00e0y. C\u00e1c thu\u1ed1c \u0111\u01b0\u1eddng u\u1ed1ng kh\u00e1c \u0111\u01b0\u1ee3c xem l\u00e0 l\u1ef1a ch\u1ecdn h\u00e0ng th\u1ee9 hai. H\u1ed9i Ti\u00eau h\u00f3a, Gan m\u1eadt v\u00e0 Dinh d\u01b0\u1ee1ng Nhi khoa B\u1eafc M\u1ef9 khuy\u1ebfn c\u00e1o th\u1ee5t ph\u00e2n m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y trong 3-6 ng\u00e0y nh\u01b0 bi\u1ec7n ph\u00e1p h\u00e0ng th\u1ee9 hai n\u1ebfu kh\u00f4ng c\u00f3 s\u1eb5n Polyethylene glycol. Th\u1ee5t th\u00e1o kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho tr\u1ebb nh\u0169 nhi; do \u0111\u00f3, thu\u1ed1c \u0111\u1eb7t tr\u1ef1c tr\u00e0ng glycerin th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng thay th\u1ebf. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 \u0111\u01b0\u1eddng tr\u1ef1c tr\u00e0ng \u0111\u1ec3 l\u00e0m s\u1ea1ch ph\u00e2n \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong B\u1ea3ng 1.<\/p>\n<p>N\u1ebfu vi\u1ec7c l\u00e0m s\u1ea1ch ph\u00e2n \u1ee9 kh\u00f4ng th\u00e0nh c\u00f4ng t\u1ea1i nh\u00e0, tr\u1ebb c\u1ea7n \u0111\u01b0\u1ee3c nh\u1eadp vi\u1ec7n \u0111\u1ec3 c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng polyethylene glycol qua sonde m\u0169i \u2013 d\u1ea1 d\u00e0y. Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u 10 mL\/kg\/gi\u1edd v\u00e0 t\u0103ng th\u00eam 10-20 mL m\u1ed7i 1-2 gi\u1edd, cho \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a 40 mL\/kg\/gi\u1edd.<\/p>\n<p>B\u1ea3ng 1. C\u00e1c li\u1ec7u ph\u00e1p l\u00e0m s\u1ea1ch ph\u00e2n \u1ee9 \u1edf tr\u1ebb em<\/p>\n<table style=\"width: 75.1789%;\" width=\"602\">\n<tbody>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">Li\u1ec7u ph\u00e1p<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\">Li\u1ec1u d\u00f9ng<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">\u0110\u01b0\u1eddng u\u1ed1ng<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\"><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">Polyethylene glycol (Miralax)*<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\">1 &#8211; 1,5 g\/kg\/ng\u00e0y<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">Lactulose<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\">1 mL\/kg, 2 l\u1ea7n\/ng\u00e0y, t\u1ed1i \u0111a 12 tu\u1ea7n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">Magnesium citrate<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\">4 mL\/kg\/ng\u00e0y<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">\u0110\u01b0\u1eddng tr\u1ef1c tr\u00e0ng (Enema, 1 l\u1ea7n\/ng\u00e0y trong 3\u20136 ng\u00e0y)<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\"><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">Saline (n\u01b0\u1edbc mu\u1ed1i)<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\">5 &#8211; 10 mL\/kg, d\u00f9ng bu\u1ed5i t\u1ed1i<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">D\u1ea7u kho\u00e1ng (Mineral oil)<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\">15 &#8211; 30 mL cho m\u1ed7i n\u0103m tu\u1ed5i, t\u1ed1i \u0111a 240 mL<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">Sodium phosphate<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\">&lt; 2 tu\u1ed5i: kh\u00f4ng d\u00f9ng (nguy c\u01a1 r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i)<\/p>\n<p>2-4 tu\u1ed5i: 30 mL, 2-3 bu\u1ed5i t\u1ed1i li\u00ean ti\u1ebfp<\/p>\n<p>5-11 tu\u1ed5i: 67 mL, 2-3 bu\u1ed5i t\u1ed1i li\u00ean ti\u1ebfp<\/p>\n<p>\u2265 12 tu\u1ed5i: 133 mL, 2-3 bu\u1ed5i t\u1ed1i li\u00ean ti\u1ebfp<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">Thu\u1ed1c \u0111\u1eb7t (Suppository, 1 l\u1ea7n\/ng\u00e0y)<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\"><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">Bisacodyl (Dulcolax)<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\">\u2265 2 tu\u1ed5i: 5 \u2013 10 mg (0,5 \u2013 1 vi\u00ean \u0111\u1eb7t)<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 49.0033%;\" width=\"301\">Glycerin*<\/td>\n<td style=\"width: 49.0033%;\" width=\"301\">0,5 &#8211; 1 vi\u00ean \u0111\u1eb7t tr\u1ebb nh\u1ecf \u0111\u1ed1i v\u1edbi tr\u1ebb \u2264 5 tu\u1ed5i Vi\u00ean \u0111\u1eb7t ng\u01b0\u1eddi l\u1edbn \u0111\u1ed1i v\u1edbi tr\u1ebb \u2265 6 tu\u1ed5i<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 98.0066%;\" colspan=\"2\" rowspan=\"2\" width=\"602\">Kh\u00e1c<\/p>\n<p>L\u1ea5y ph\u00e2n b\u1eb1ng tay (Manual, hi\u1ebfm d\u00f9ng; c\u1ea7n g\u00e2y m\u00ea to\u00e0n th\u00e2n) \u2014<\/p>\n<p>C\u00f3 th\u1ec3 d\u00f9ng cho tr\u1ebb &lt; 1 tu\u1ed5i. (Ngu\u1ed3n: \u0111i\u1ec1u ch\u1ec9nh t\u1eeb Nurko S, Zimmerman LA. <em>Evaluation and treatment of constipation in children and adolescents<\/em>. Am Fam Physician. 2014;90(2):87, b\u1ed5 sung th\u00eam t\u1eeb t\u00e0i li\u1ec7u tham kh\u1ea3o).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>\u0110I\u1ec0U TR\u1eca DUY TR\u00cc<\/h2>\n<p>\u0110i\u1ec1u tr\u1ecb duy tr\u00ec n\u00ean \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u \u1edf tr\u1ebb kh\u00f4ng c\u00f3 \u1ee9 ph\u00e2n, ho\u1eb7c sau khi t\u00ecnh tr\u1ea1ng \u1ee9 ph\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft. M\u1ee5c ti\u00eau c\u1ee7a \u0111i\u1ec1u tr\u1ecb duy tr\u00ec l\u00e0 gi\u00fap tr\u1ebb \u0111i ph\u00e2n m\u1ec1m h\u00e0ng ng\u00e0y ho\u1eb7c c\u00e1ch ng\u00e0y, \u0111\u1ed3ng th\u1eddi ng\u0103n ng\u1eeba t\u00e1i ph\u00e1t t\u00ecnh tr\u1ea1ng \u1ee9 ph\u00e2n.<\/p>\n<p>Polyethylene glycol \u0111\u01b0\u1ee3c ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 h\u01a1n c\u00e1c thu\u1ed1c nhu\u1eadn tr\u00e0ng \u0111\u01b0\u1eddng u\u1ed1ng kh\u00e1c v\u00e0 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u trong \u0111i\u1ec1u tr\u1ecb duy tr\u00ec t\u00e1o b\u00f3n. Li\u1ec1u kh\u1edfi \u0111\u1ea7u duy tr\u00ec c\u1ee7a polyethylene glycol l\u00e0 0.4 g\/kg\/ng\u00e0y ; ng\u01b0\u1eddi ch\u0103m s\u00f3c n\u00ean \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn r\u1eb1ng li\u1ec1u c\u00f3 th\u1ec3 t\u0103ng ho\u1eb7c gi\u1ea3m \u0111\u1ec3 duy tr\u00ec ph\u00e2n m\u1ec1m m\u1ed7i ng\u00e0y ho\u1eb7c c\u00e1ch ng\u00e0y, m\u00e0 kh\u00f4ng g\u00e2y ti\u00eau ch\u1ea3y. Polyethylene glycol n\u00ean \u0111\u01b0\u1ee3c xem l\u00e0 an to\u00e0n khi d\u00f9ng l\u00e2u d\u00e0i cho tr\u1ebb em. Lactulose l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb duy tr\u00ec h\u00e0ng th\u1ee9 hai n\u1ebfu polyethylene glycol kh\u00f4ng c\u00f3 s\u1eb5n. C\u00e1c l\u1ef1a ch\u1ecdn h\u00e0ng th\u1ee9 hai kh\u00e1c bao g\u1ed3m s\u1eefa magie, thu\u1ed1c nhu\u1eadn tr\u00e0ng k\u00edch th\u00edch.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb duy tr\u00ec n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c \u00edt nh\u1ea5t 2 th\u00e1ng, ho\u1eb7c \u00edt nh\u1ea5t 1 th\u00e1ng sau khi c\u00f3 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi \u0111i\u1ec1u tr\u1ecb. Thu\u1ed1c c\u1ea7n \u0111\u01b0\u1ee3c gi\u1ea3m li\u1ec1u d\u1ea7n d\u1ea7n v\u00e0 trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 ph\u1ea3i duy tr\u00ec trong nhi\u1ec1u th\u00e1ng \u0111\u1ebfn nhi\u1ec1u n\u0103m. N\u1ebfu t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng xu\u1ea5t hi\u1ec7n tr\u01b0\u1edbc khi tr\u1ebb \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n \u0111i v\u1ec7 sinh, th\u00ec vi\u1ec7c \u0111i\u1ec1u tr\u1ecb duy tr\u00ec n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c cho \u0111\u1ebfn khi tr\u1ebb ho\u00e0n t\u1ea5t qu\u00e1 tr\u00ecnh t\u1eadp \u0111i v\u1ec7 sinh. T\u00e1i ph\u00e1t l\u00e0 t\u00ecnh tr\u1ea1ng th\u01b0\u1eddng g\u1eb7p v\u00e0 n\u00ean \u0111\u01b0\u1ee3c x\u1eed tr\u00ed b\u1eb1ng \u0111i\u1ec1u tr\u1ecb duy tr\u00ec ho\u1eb7c l\u00e0m s\u1ea1ch ph\u00e2n \u1ee9 khi c\u1ea7n thi\u1ebft.<\/p>\n<p>Trong m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p, can thi\u1ec7p ngo\u1ea1i khoa l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u00e1o b\u00f3n kh\u00e1ng tr\u1ecb.<\/p>\n<p>B\u1ea3ng 2. \u0110i\u1ec1u tr\u1ecb duy tr\u00ec t\u00e1o b\u00f3n \u1edf tr\u1ebb em<\/p>\n<table width=\"602\">\n<tbody>\n<tr>\n<td width=\"201\">Li\u1ec7u ph\u00e1p<\/td>\n<td width=\"201\">Li\u1ec1u d\u00f9ng<\/td>\n<td width=\"201\">T\u00e1c d\u1ee5ng ph\u1ee5<\/td>\n<\/tr>\n<tr>\n<td width=\"201\">Thu\u1ed1c th\u1ea9m th\u1ea5u h\u00e0ng \u0111\u1ea7u<\/td>\n<td width=\"201\"><\/td>\n<td width=\"201\"><\/td>\n<\/tr>\n<tr>\n<td width=\"201\">Polyethylene glycol (Miralax)*<\/td>\n<td width=\"201\">0,4 &#8211; 1,5 g\/kg, t\u1ed1i \u0111a 17 g\/ng\u00e0y<\/td>\n<td width=\"201\">Ph\u00e2n v\u1ec7, \u0111\u1ea7y h\u01a1i<\/td>\n<\/tr>\n<tr>\n<td width=\"201\">Thu\u1ed1c th\u1ea9m th\u1ea5u h\u00e0ng th\u1ee9 hai<\/td>\n<td width=\"201\"><\/td>\n<td width=\"201\"><\/td>\n<\/tr>\n<tr>\n<td width=\"201\">Lactulose*<\/td>\n<td width=\"201\">1 &#8211; 3 mL\/kg\/ng\u00e0y, chia 2 l\u1ea7n<\/td>\n<td width=\"201\">\u0110au qu\u1eb7n b\u1ee5ng, \u0111\u1ea7y h\u01a1i<\/td>\n<\/tr>\n<tr>\n<td width=\"201\">S\u1eefa magi\u00ea (magnesium hydroxide)<\/td>\n<td width=\"201\">&lt; 2 tu\u1ed5i: 0,5 mL\/kg\/ng\u00e0y<\/p>\n<p>2-5 tu\u1ed5i: 5-15 mL\/ng\u00e0y<\/p>\n<p>6-11 tu\u1ed5i: 15-30 mL\/ng\u00e0y<\/p>\n<p>\u2265 12 tu\u1ed5i: 30-60 mL\/ng\u00e0y (C\u00f3 th\u1ec3 d\u00f9ng li\u1ec1u duy nh\u1ea5t bu\u1ed5i t\u1ed1i ho\u1eb7c chia nhi\u1ec1u l\u1ea7n)<\/td>\n<td width=\"201\">Tr\u1ebb s\u01a1 sinh d\u1ec5 b\u1ecb qu\u00e1 li\u1ec1u magi\u00ea (t\u0103ng magnesi m\u00e1u, t\u0103ng phospho m\u00e1u, gi\u1ea3m calci m\u00e1u)<\/td>\n<\/tr>\n<tr>\n<td width=\"201\">Sorbitol (v\u1ecb d\u1ee5: n\u01b0\u1edbc \u00e9p m\u1eadn)*<\/td>\n<td width=\"201\">1 &#8211; 3 mL\/kg, 1-2 l\u1ea7n\/ng\u00e0y \u1edf tr\u1ebb nh\u0169 nhi<\/td>\n<td width=\"201\">Gi\u1ed1ng lactulose<\/td>\n<\/tr>\n<tr>\n<td width=\"201\">Thu\u1ed1c k\u00edch th\u00edch<\/td>\n<td width=\"201\"><\/td>\n<td width=\"201\"><\/td>\n<\/tr>\n<tr>\n<td width=\"201\">Bisacodyl (Dulcolax)<\/td>\n<td width=\"201\">3-12 tu\u1ed5i: 5-10 mg (1-2 vi\u00ean)\/ng\u00e0y<\/p>\n<p>&gt; 12 tu\u1ed5i: 5-15 mg (1-3 vi\u00ean)\/ng\u00e0y<\/td>\n<td width=\"201\">\u0110au qu\u1eb7n b\u1ee5ng, ti\u00eau ch\u1ea3y, h\u1ea1 kali m\u00e1u, b\u1ea5t th\u01b0\u1eddng ni\u00eam m\u1ea1c tr\u1ef1c tr\u00e0ng, vi\u00eam tr\u1ef1c tr\u00e0ng (hi\u1ebfm), s\u1ecfi ti\u1ebft ni\u1ec7u (\u0111\u01b0\u1ee3c b\u00e1o c\u00e1o)<\/td>\n<\/tr>\n<tr>\n<td width=\"201\">Senna*<\/td>\n<td width=\"201\">1-2 tu\u1ed5i: 1,25-2,5 mL (2,2-4,4 mg) bu\u1ed5i t\u1ed1i; t\u1ed1i \u0111a 5 mL ho\u1eb7c 8,8 mg\/ng\u00e0y<\/p>\n<p>3-6 tu\u1ed5i: 2,5-3,75 mL (4,4-6,6 mg) ho\u1eb7c 0,5 vi\u00ean (4,3 mg) bu\u1ed5i t\u1ed1i; t\u1ed1i \u0111a 7,5 mL ho\u1eb7c 1 vi\u00ean\/ng\u00e0y<\/p>\n<p>7-12 tu\u1ed5i: 5-7,5 mL (8,8-13,2 mg) ho\u1eb7c 1 vi\u00ean (8,6 mg) bu\u1ed5i t\u1ed1i; t\u1ed1i \u0111a 15 mL ho\u1eb7c 2 vi\u00ean\/ng\u00e0y<\/p>\n<p>&gt; 12 tu\u1ed5i: 10-15 mL (26,4 mg) ho\u1eb7c 2 vi\u00ean (17,2 mg) bu\u1ed5i t\u1ed1i; t\u1ed1i \u0111a 30 mL ho\u1eb7c 4 vi\u00ean\/ng\u00e0y<\/td>\n<td width=\"201\">Vi\u00eam gan, ph\u00ec \u0111\u1ea1i x\u01b0\u01a1ng kh\u1edbp, b\u1ec7nh th\u1eadn do thu\u1ed1c gi\u1ea3m \u0111au<\/td>\n<\/tr>\n<tr>\n<td width=\"201\">Ch\u1ea5t b\u00f4i tr\u01a1n<\/td>\n<td width=\"201\"><\/td>\n<td width=\"201\"><\/td>\n<\/tr>\n<tr>\n<td width=\"201\">D\u1ea7u kho\u00e1ng (Mineral oil)<\/td>\n<td width=\"201\">1-3 mL\/kg\/ng\u00e0y, chia 2 l\u1ea7n<\/td>\n<td width=\"201\">Vi\u00eam ph\u1ed5i do d\u1ea7u (n\u1ebfu h\u00edt ph\u1ea3i), c\u00f3 th\u1ec3 c\u1ea3n tr\u1edf h\u1ea5p thu vitamin tan trong d\u1ea7u<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"602\">C\u00f3 th\u1ec3 d\u00f9ng cho tr\u1ebb d\u01b0\u1edbi 1 tu\u1ed5i. (Ngu\u1ed3n: \u0111i\u1ec1u ch\u1ec9nh t\u1eeb Nurko S, Zimmerman LA. <em>Evaluation and treatment of constipation in children and adolescents<\/em>. Am Fam Physician. 2014;90(2):88, b\u1ed5 sung th\u00eam t\u1eeb t\u00e0i li\u1ec7u tham kh\u1ea3o 15).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n<ol>\n<li>Mulhem E, Khondoker F, Kandiah S. Constipation in Children and Adolescents: Evaluation and Treatment. Am Fam Physician. 2022 May 1;105(5):469-478. PMID: 35559625.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>T\u00e1o b\u00f3n \u1edf tr\u1ebb em th\u01b0\u1eddng l\u00e0 t\u00e1o b\u00f3n ch\u1ee9c n\u0103ng kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n th\u1ef1c th\u1ec3. C\u00e1c nguy\u00ean nh\u00e2n th\u1ef1c th\u1ec3 g\u00e2y t\u00e1o b\u00f3n \u1edf tr\u1ebb em bao g\u1ed3m b\u1ec7nh Hirschsprung, x\u01a1 nang v\u00e0 d\u1ecb t\u1eadt c\u1ed9t s\u1ed1ng th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u c\u1ea5p \u0111\u1ecf. B\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 [&#8230;]\n","protected":false},"author":1,"featured_media":134345,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-134341","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134341","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=134341"}],"version-history":[{"count":6,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134341\/revisions"}],"predecessor-version":[{"id":135537,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134341\/revisions\/135537"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/134345"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=134341"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=134341"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=134341"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}