{"id":157293,"date":"2026-05-07T11:54:17","date_gmt":"2026-05-07T04:54:17","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=157293"},"modified":"2026-05-07T11:55:51","modified_gmt":"2026-05-07T04:55:51","slug":"quan-ly-xuat-huyet-tieu-hoa-tren-theo-acg-2021","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/quan-ly-xuat-huyet-tieu-hoa-tren-theo-acg-2021\/","title":{"rendered":"QU\u1ea2N L\u00dd XU\u1ea4T HUY\u1ebeT TI\u00caU H\u00d3A TR\u00caN THEO ACG 2021"},"content":{"rendered":"

B\u1ea3n d\u1ecbch: QU\u1ea2N L\u00dd XU\u1ea4T HUY\u1ebeT TI\u00caU H\u00d3A TR\u00caN THEO ACG 2021 – \u0110\u01b0\u1ee3c d\u1ecbch b\u1edfi NT HN<\/p>\n

\u0110\u1ec1 xu\u1ea5t \u0111\u00e1nh gi\u00e1 nguy c\u01a1 t\u1ea1i khoa c\u1ea5p c\u1ee9u \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n nguy c\u01a1 r\u1ea5t th\u1ea5p (v\u00ed d\u1ee5: \u0111i\u1ec3m Glasgow-Blatchford 0-1) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c cho xu\u1ea5t vi\u1ec7n v\u00e0 theo d\u00f5i ngo\u1ea1i tr\u00fa. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u00ec xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean, ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t truy\u1ec1n h\u1ed3ng c\u1ea7u khi ng\u01b0\u1ee1ng hemoglobin l\u00e0 7 g\/dL. Khuy\u1ebfn c\u00e1o truy\u1ec1n erythromycin tr\u01b0\u1edbc khi n\u1ed9i soi, v\u00e0 n\u00ean th\u1ef1c hi\u1ec7n n\u1ed9i soi trong v\u00f2ng 24 gi\u1edd sau khi nh\u1eadp vi\u1ec7n. \u0110i\u1ec1u tr\u1ecb n\u1ed9i soi \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ed1i v\u1edbi c\u00e1c \u1ed5 lo\u00e9t \u0111ang ch\u1ea3y m\u00e1u th\u00e0nh tia ho\u1eb7c r\u1ec9 m\u00e1u, c\u0169ng nh\u01b0 c\u00e1c m\u1ea1ch m\u00e1u l\u1ed9 kh\u00f4ng ch\u1ea3y m\u00e1u. Sau khi c\u1ea7m m\u00e1u qua n\u1ed9i soi, khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thu\u1ed1c PPI li\u1ec1u cao, truy\u1ec1n li\u00ean t\u1ee5c ho\u1eb7c ng\u1eaft qu\u00e3ng trong 3 ng\u00e0y, sau \u0111\u00f3 d\u00f9ng thu\u1ed1c PPI \u0111\u01b0\u1eddng u\u1ed1ng 2 l\u1ea7n trong 2 tu\u1ea7n \u0111\u1ea7u sau n\u1ed9i soi. N\u00ean n\u1ed9i soi l\u1ea1i n\u1ebfu ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t, v\u00e0 n\u1ebfu \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi th\u1ea5t b\u1ea1i, khuy\u1ebfn c\u00e1o thuy\u00ean t\u1eafc m\u1ea1ch qua catheter.<\/p>\n

DANH S\u00c1CH C\u00c1C KHUY\u1ebeN C\u00c1O TRONG H\u01af\u1edaNG D\u1eaaN<\/h2>\n
Ph\u00e2n t\u1ea7ng nguy c\u01a1<\/strong><\/p>\n
1. Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ebfn khoa c\u1ea5p c\u1ee9u v\u1edbi xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean (UGIB) \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i nguy c\u01a1 r\u1ea5t th\u1ea5p \u2013 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00f3 \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 nguy c\u01a1 v\u1edbi t\u1ef7 l\u1ec7 \u00e2m t\u00ednh gi\u1ea3 \u2264 1% \u0111\u1ed1i v\u1edbi k\u1ebft c\u1ee5c c\u1ea7n can thi\u1ec7p t\u1ea1i b\u1ec7nh vi\u1ec7n ho\u1eb7c t\u1eed vong (v\u00ed d\u1ee5: \u0111i\u1ec3m Glasgow-Blatchford 0-1) \u2013 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c cho xu\u1ea5t vi\u1ec7n v\u00e0 theo d\u00f5i ngo\u1ea1i tr\u00fa thay v\u00ec nh\u1eadp vi\u1ec7n (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p).<\/p>\n
Truy\u1ec1n h\u1ed3ng c\u1ea7u<\/strong><\/p>\n
2. Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t chi\u1ebfn l\u01b0\u1ee3c truy\u1ec1n h\u1ed3ng c\u1ea7u h\u1ea1n ch\u1ebf, v\u1edbi ng\u01b0\u1ee1ng truy\u1ec1n khi hemoglobin l\u00e0 7 g\/dL \u1edf b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng th\u1ea5p).<\/p>\n
\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa tr\u01b0\u1edbc n\u1ed9i soi<\/strong><\/p>\n
3.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t truy\u1ec1n erythromycin tr\u01b0\u1edbc khi n\u1ed9i soi \u1edf b\u1ec7nh nh\u00e2n UGIB (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p).<\/p>\n
4.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i ch\u01b0a th\u1ec3 \u0111\u01b0a ra khuy\u1ebfn c\u00e1o \u1ee7ng h\u1ed9 hay ph\u1ea3n \u0111\u1ed1i vi\u1ec7c s\u1eed d\u1ee5ng PPI tr\u01b0\u1edbc n\u1ed9i soi \u1edf b\u1ec7nh nh\u00e2n UGIB.
\nN\u1ed9i soi trong xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean<\/p>\n
5.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n ho\u1eb7c \u0111ang \u0111\u01b0\u1ee3c theo d\u00f5i t\u1ea1i b\u1ec7nh vi\u1ec7n v\u00ec UGIB n\u00ean \u0111\u01b0\u1ee3c n\u1ed9i soi trong v\u00f2ng 24 gi\u1edd k\u1ec3 t\u1eeb khi nh\u1eadp vi\u1ec7n (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p).<\/p>\n
6.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi \u1edf b\u1ec7nh nh\u00e2n UGIB do lo\u00e9t c\u00f3 ch\u1ea3y m\u00e1u th\u00e0nh tia, ch\u1ea3y m\u00e1u r\u1ec9 r\u1ea3, ho\u1eb7c c\u00f3 m\u1ea1ch m\u00e1u l\u1ed9 kh\u00f4ng ch\u1ea3y m\u00e1u (khuy\u1ebfn c\u00e1o m\u1ea1nh, ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng trung b\u00ecnh).7.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i ch\u01b0a \u0111\u01b0a ra khuy\u1ebfn c\u00e1o \u1ee7ng h\u1ed9 hay ph\u1ea3n \u0111\u1ed1i \u0111i\u1ec1u tr\u1ecb n\u1ed9i<\/p>\n
soi \u1edf b\u1ec7nh nh\u00e2n UGIB do lo\u00e9t c\u00f3 c\u1ee5c m\u00e1u \u0111\u00f4ng b\u00e1m d\u00ednh.<\/p>\n
8.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb c\u1ea7m m\u00e1u n\u1ed9i soi b\u1eb1ng \u0111\u1ed1t \u0111i\u1ec7n, \u0111\u1ea7u d\u00f2 nhi\u1ec7t, ho\u1eb7c ti\u00eam ethanol cho b\u1ec7nh nh\u00e2n UGIB do lo\u00e9t (khuy\u1ebfn c\u00e1o m\u1ea1nh, ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng trung b\u00ecnh).<\/p>\n
9.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t \u0111i\u1ec1u tr\u1ecb c\u1ea7m m\u00e1u n\u1ed9i soi b\u1eb1ng clips, argon, ho\u1eb7c \u0111\u1ed1t \u0111i\u1ec7n \u0111\u01a1n c\u1ef1c cho b\u1ec7nh nh\u00e2n UGIB do lo\u00e9t (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng t\u1eeb r\u1ea5t th\u1ea5p \u0111\u1ebfn th\u1ea5p).<\/p>\n
10.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o kh\u00f4ng s\u1eed d\u1ee5ng epinephrine \u0111\u01a1n \u0111\u1ed9c cho b\u1ec7nh nh\u00e2n UGIB do lo\u00e9t, m\u00e0 n\u00ean ph\u1ed1i h\u1ee3p v\u1edbi m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p c\u1ea7m m\u00e1u kh\u00e1c (khuy\u1ebfn c\u00e1o m\u1ea1nh, ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng t\u1eeb r\u1ea5t th\u1ea5p \u0111\u1ebfn trung b\u00ecnh).<\/p>\n
11.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t \u0111i\u1ec1u tr\u1ecb c\u1ea7m m\u00e1u n\u1ed9i soi b\u1eb1ng b\u1ed9t c\u1ea7m m\u00e1u TC-325 cho b\u1ec7nh nh\u00e2n c\u00f3 lo\u00e9t \u0111ang ch\u1ea3y m\u00e1u (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p).<\/p>\n
12.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t s\u1eed d\u1ee5ng clip over-the-scope nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p c\u1ea7m m\u00e1u cho b\u1ec7nh nh\u00e2n b\u1ecb ch\u1ea3y m\u00e1u do lo\u00e9t t\u00e1i ph\u00e1t sau khi \u0111\u00e3 c\u1ea7m m\u00e1u n\u1ed9i soi th\u00e0nh c\u00f4ng tr\u01b0\u1edbc \u0111\u00f3 (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng th\u1ea5p).<\/p>\n
\u0110i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf ti\u1ebft acid sau c\u1ea7m m\u00e1u n\u1ed9i soi trong lo\u00e9t ch\u1ea3y m\u00e1u<\/strong><\/p>\n
13.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng PPI li\u1ec1u cao, truy\u1ec1n li\u00ean t\u1ee5c ho\u1eb7c ng\u1eaft qu\u00e3ng trong 3 ng\u00e0y sau khi \u0111\u00e3 c\u1ea7m m\u00e1u n\u1ed9i soi th\u00e0nh c\u00f4ng cho lo\u00e9t ch\u1ea3y m\u00e1u (khuy\u1ebfn c\u00e1o m\u1ea1nh, ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng t\u1eeb trung b\u00ecnh \u0111\u1ebfn cao).<\/p>\n
14.\u00a0\u00a0 \u00a0Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n nguy c\u01a1 cao b\u1ecb UGIB do lo\u00e9t, sau khi \u0111\u00e3 c\u1ea7m m\u00e1u n\u1ed9i soi v\u00e0 \u0111i\u1ec1u tr\u1ecb PPI li\u1ec1u cao ng\u1eafn h\u1ea1n t\u1ea1i b\u1ec7nh vi\u1ec7n, n\u00ean ti\u1ebfp t\u1ee5c d\u00f9ng PPI \u0111\u01b0\u1eddng u\u1ed1ng ng\u00e0y 2 l\u1ea7n cho \u0111\u1ebfn 2 tu\u1ea7n sau l\u1ea7n n\u1ed9i soi ban \u0111\u1ea7u (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng th\u1ea5p).<\/p>\n
Ch\u1ea3y m\u00e1u \u1ed5 lo\u00e9t t\u00e1i ph\u00e1t sau khi \u0111\u00e3 c\u1ea7m m\u00e1u n\u1ed9i soi th\u00e0nh c\u00f4ng<\/strong><\/p>\n
15. Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t sau \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi cho lo\u00e9t ch\u1ea3y m\u00e1u n\u00ean \u0111\u01b0\u1ee3c n\u1ed9i soi l\u1ea1i v\u00e0 ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi, thay v\u00ec ph\u1eabu thu\u1eadt ho\u1eb7c thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch qua catheter.<\/p>\n
Th\u1ea5t b\u1ea1i c\u1ee7a \u0111i\u1ec1u tr\u1ecb c\u1ea7m m\u00e1u n\u1ed9i soi \u0111\u1ed1i v\u1edbi lo\u00e9t ch\u1ea3y m\u00e1u<\/strong><\/p>\n
16. Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n lo\u00e9t ch\u1ea3y m\u00e1u kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ti\u1ebfp theo b\u1eb1ng thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch qua catheter (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p).<\/p>\n

T\u1ed4NG QUAN<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/th>\n \u0110i\u1ec3m<\/th>\n<\/tr>\n
BUN (mg\/dL)<\/td>\n <\/td>\n<\/tr>\n
18.2 \u0111\u1ebfn < 22.4<\/td>\n 2<\/td>\n<\/tr>\n
22.4 \u0111\u1ebfn < 28<\/td>\n 3<\/td>\n<\/tr>\n
28 \u0111\u1ebfn < 70<\/td>\n 4<\/td>\n<\/tr>\n
\u2265 70<\/td>\n 6<\/td>\n<\/tr>\n
Hemoglobin (g\/dL)<\/td>\n <\/td>\n<\/tr>\n
12 \u0111\u1ebfn < 13 (nam); 10 \u0111\u1ebfn < 12 (n\u1eef)<\/td>\n 1<\/td>\n<\/tr>\n
10 \u0111\u1ebfn < 12 (nam)<\/td>\n 3<\/td>\n<\/tr>\n
< 10<\/td>\n 6<\/td>\n<\/tr>\n
Huy\u1ebft \u00e1p t\u00e2m thu (mmHg)<\/td>\n <\/td>\n<\/tr>\n
100 – 109<\/td>\n 1<\/td>\n<\/tr>\n
90 – 99<\/td>\n 2<\/td>\n<\/tr>\n
< 90<\/td>\n 3<\/td>\n<\/tr>\n
Nh\u1ecbp tim (l\u1ea7n\/ph\u00fat)<\/td>\n <\/td>\n<\/tr>\n
\u2265 100<\/td>\n 1<\/td>\n<\/tr>\n
B\u1ec7nh l\u00fd gan v\u00e0 suy tim kh\u00f4ng n\u1eb1m trong thang \u0111i\u1ec3m g\u1ed1c c\u1ee7a Glasgow-Blatchford. M\u1ed9t nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y \u0111\u1ecbnh ngh\u0129a b\u1ec7nh l\u00fd gan \u0111\u00e3 bi\u1ebft, ho\u1eb7c b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng b\u1ec7nh gan m\u1ea1n t\u00ednh ho\u1eb7c c\u1ea5p t\u00ednh, ho\u1eb7c l\u00e2m s\u00e0ng v\u00e0 b\u1eb1ng ch\u1ee9ng si\u00eau \u00e2m tim c\u1ee7a suy tim.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ph\u00e2n t\u1ea7ng nguy c\u01a1<\/h3>\n
Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u1ebfn khoa c\u1ea5p c\u1ee9u v\u1edbi xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean (UGIB) \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i nguy c\u01a1 r\u1ea5t th\u1ea5p \u2013 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00f3 \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 nguy c\u01a1 v\u1edbi t\u1ef7 l\u1ec7 \u00e2m t\u00ednh gi\u1ea3 \u2264 1% \u0111\u1ed1i v\u1edbi k\u1ebft c\u1ee5c c\u1ea7n can thi\u1ec7p t\u1ea1i b\u1ec7nh vi\u1ec7n ho\u1eb7c t\u1eed vong (v\u00ed d\u1ee5: \u0111i\u1ec3m Glasgow-Blatchford 0-1) \u2013 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c cho xu\u1ea5t vi\u1ec7n v\u00e0 theo d\u00f5i ngo\u1ea1i tr\u00fa thay v\u00ec nh\u1eadp vi\u1ec7n (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p).<\/strong><\/p>\n
T\u00f3m t\u1eaft b\u1eb1ng ch\u1ee9ng<\/h4>\n
M\u1ee5c ti\u00eau c\u1ee7a vi\u1ec7c x\u00e1c \u0111\u1ecbnh nh\u00f3m b\u1ec7nh nh\u00e2n nguy c\u01a1 r\u1ea5t th\u1ea5p l\u00e0 cho ph\u00e9p m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n an to\u00e0n t\u1eeb khoa c\u1ea5p c\u1ee9u v\u00e0 theo d\u00f5i ngo\u1ea1i tr\u00fa, qua \u0111\u00f3 gi\u1ea3m chi ph\u00ed v\u1edbi r\u1ea5t \u00edt ho\u1eb7c h\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3 nguy c\u01a1 x\u1ea3y ra c\u00e1c k\u1ebft c\u1ee5c x\u1ea5u c\u1ea7n can thi\u1ec7p ho\u1eb7c l\u1ebd ra c\u00f3 th\u1ec3 ph\u00f2ng tr\u00e1nh n\u1ebfu \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa. Do \u0111\u00f3, l\u1ee3i \u00edch ch\u00ednh c\u1ee7a khuy\u1ebfn c\u00e1o n\u00e0y mang t\u00ednh kinh t\u1ebf nh\u1edd gi\u1ea3m s\u1ed1 ca nh\u1eadp vi\u1ec7n.
\nC\u00e1c k\u1ebft c\u1ee5c g\u1ed9p th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 nguy c\u01a1. Ch\u00fang t\u00f4i ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o c\u00e1c k\u1ebft c\u1ee5c g\u1ed9p nh\u01b0 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a trong c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 \u0111\u01b0\u1ee3c xem x\u00e9t, v\u00ec ch\u00fang \u0111\u01b0\u1ee3c xem l\u00e0 ph\u00f9 h\u1ee3p h\u01a1n so v\u1edbi c\u00e1c k\u1ebft c\u1ee5c \u0111\u01a1n l\u1ebb nh\u01b0 t\u00e1i xu\u1ea5t huy\u1ebft ho\u1eb7c t\u1eed vong khi x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n nguy c\u01a1 r\u1ea5t th\u1ea5p. K\u1ebft c\u1ee5c g\u1ed9p trong 4 nghi\u00ean c\u1ee9u ri\u00eang l\u1ebb m\u00e0 ch\u00fang t\u00f4i \u0111\u00e1nh gi\u00e1 bao g\u1ed3m c\u00e1c can thi\u1ec7p t\u1ea1i b\u1ec7nh vi\u1ec7n cho v\u1ea5n \u0111\u1ec1 xu\u1ea5t huy\u1ebft (truy\u1ec1n m\u00e1u v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p c\u1ea7m m\u00e1u) v\u00e0 t\u1eed vong, trong khi t\u1ed5ng quan h\u1ec7 th\u1ed1ng c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c c\u00f2n bao g\u1ed3m th\u00eam t\u00ecnh tr\u1ea1ng t\u00e1i xu\u1ea5t huy\u1ebft d\u1eabn \u0111\u1ebfn t\u00e1i nh\u1eadp vi\u1ec7n trong k\u1ebft c\u1ee5c g\u1ed9p.<\/p>\n
\u0110\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ed9 nh\u1ea1y cao – nh\u1eb1m gi\u1ea3m thi\u1ec3u c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u00e2m t\u00ednh gi\u1ea3 – l\u00e0 y\u1ebfu t\u1ed1 then ch\u1ed1t khi \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh v\u1ec1 qu\u1ea3n l\u00fd ngo\u1ea1i tr\u00fa. \u00c2m t\u00ednh gi\u1ea3 x\u1ea3y ra khi nh\u1eefng b\u1ec7nh nh\u00e2n th\u1ef1c s\u1ef1 c\u1ea7n can thi\u1ec7p ho\u1eb7c c\u00f3 nguy c\u01a1 t\u1eed vong l\u1ea1i b\u1ecb ph\u00e2n lo\u1ea1i sai b\u1eb1ng c\u00f4ng c\u1ee5 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 l\u00e0 kh\u00f4ng c\u1ea7n can thi\u1ec7p ho\u1eb7c kh\u00f4ng c\u00f3 nguy c\u01a1 t\u1eed vong. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u1ec7c cho xu\u1ea5t vi\u1ec7n nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e1ng l\u1ebd c\u1ea7n can thi\u1ec7p ho\u1eb7c c\u00f3 th\u1ec3 t\u1eed vong. M\u1ee5c ti\u00eau l\u00fd t\u01b0\u1edfng l\u00e0 kh\u00f4ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p \u00e2m t\u00ednh gi\u1ea3 (\u0111\u1ed9 nh\u1ea1y 100%), nh\u01b0ng b\u00e1c s\u0129 v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc m\u1ee9c \u0111\u1ed9 ch\u1eafc ch\u1eafn c\u1ea7n thi\u1ebft \u0111\u1ec3 c\u1ea3m th\u1ea5y an t\u00e2m khi quy\u1ebft \u0111\u1ecbnh cho xu\u1ea5t vi\u1ec7n t\u1eeb khoa c\u1ea5p c\u1ee9u.<\/p>\n
B\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m Glasgow-Blatchford b\u1eb1ng 0 c\u00f3 \u01b0\u1edbc t\u00ednh \u0111\u1ed9 nh\u1ea1y t\u1eeb 99%-100%, v\u1edbi gi\u1edbi h\u1ea1n d\u01b0\u1edbi c\u1ee7a kho\u1ea3ng tin c\u1eady 95% l\u00e0 98%, m\u1eb7c d\u00f9 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u1ea5p v\u1edbi c\u00e1c \u01b0\u1edbc t\u00ednh ch\u1ec9 t\u1eeb 8% \u0111\u1ebfn 22%. B\u1ec7nh nh\u00e2n c\u00f3 GBS = 0-1 c\u00f3 \u01b0\u1edbc t\u00ednh \u0111\u1ed9 nh\u1ea1y kho\u1ea3ng 99%, v\u1edbi c\u1eadn d\u01b0\u1edbi c\u1ee7a CI 95% l\u00e0 96%-98%; \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao h\u01a1n, v\u1edbi c\u00e1c \u01b0\u1edbc t\u00ednh \u0111i\u1ec3m dao \u0111\u1ed9ng t\u1eeb 27% \u0111\u1ebfn 40%. Hai nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m quy m\u00f4 l\u1edbn cho th\u1ea5y GBS = 0-1 g\u1eb7p \u1edf kho\u1ea3ng 19%-24% b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m v\u00ec xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean. M\u1ed9t m\u00f4 h\u00ecnh g\u1ea7n \u0111\u00e2y c\u1ee7a Shung v\u00e0 c\u1ed9ng s\u1ef1 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ed9 nh\u1ea1y 99% (t\u01b0\u01a1ng \u0111\u01b0\u01a1ng GBS = 0-1) ho\u1eb7c 100% (t\u01b0\u01a1ng \u0111\u01b0\u01a1ng GBS = 0), v\u1edbi \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao h\u01a1n GBS.
\nH\u00ecnh b\u00ean d\u01b0\u1edbi minh h\u1ecda c\u00e1ch t\u00ednh \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cho m\u1ed9t qu\u1ea7n th\u1ec3 gi\u1ea3 \u0111\u1ecbnh g\u1ed3m 250 b\u1ec7nh nh\u00e2n UGIB, s\u1eed d\u1ee5ng ng\u01b0\u1ee1ng GBS = 1 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u00f3m nguy c\u01a1 r\u1ea5t th\u1ea5p. \u0110\u1ed9 nh\u1ea1y 99% c\u00f3 ngh\u0129a l\u00e0 trong m\u1ed7i 100 b\u1ec7nh nh\u00e2n th\u1ef1c s\u1ef1 c\u1ea7n can thi\u1ec7p t\u1ea1i b\u1ec7nh vi\u1ec7n ho\u1eb7c t\u1eed vong, s\u1ebd c\u00f3 1 tr\u01b0\u1eddng h\u1ee3p \u00e2m t\u00ednh gi\u1ea3 – t\u1ee9c l\u00e0 1 b\u1ec7nh nh\u00e2n c\u00f3 GBS 0-1 b\u1ecb ph\u00e2n lo\u1ea1i sai l\u00e0 kh\u00f4ng c\u1ea7n can thi\u1ec7p ho\u1eb7c kh\u00f4ng c\u00f3 nguy c\u01a1 t\u1eed vong. Nh\u01b0 \u0111\u00e3 \u0111\u1ec1 c\u1eadp, khi \u0111\u1ed9 nh\u1ea1y cao th\u00ec \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u01b0\u1eddng th\u1ea5p. H\u00ecnh b\u00ean d\u01b0\u1edbi cho th\u1ea5y trong s\u1ed1 150 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u1ea7n can thi\u1ec7p ho\u1eb7c kh\u00f4ng t\u1eed vong, ch\u1ec9 c\u00f3 50 ng\u01b0\u1eddi \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i \u0111\u00fang l\u00e0 nguy c\u01a1 r\u1ea5t th\u1ea5p theo GBS = 0-1 (\u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 33%, t\u1ef7 l\u1ec7 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 67%). Do \u0111\u00f3, ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n kh\u00f4ng c\u1ea7n can thi\u1ec7p ho\u1eb7c kh\u00f4ng t\u1eed vong – v\u00e0 c\u00f3 th\u1ec3 kh\u00f4ng h\u01b0\u1edfng l\u1ee3i t\u1eeb nh\u1eadp vi\u1ec7n – l\u1ea1i kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i l\u00e0 nguy c\u01a1 r\u1ea5t th\u1ea5p. Vi\u1ec7c c\u1ea3i thi\u1ec7n \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u trong khi v\u1eabn duy tr\u00ec \u0111\u1ed9 nh\u1ea1y cao l\u00e0 m\u1ee5c ti\u00eau quan tr\u1ecdng trong ph\u00e1t tri\u1ec3n m\u00f4 h\u00ecnh \u0111\u00e1nh gi\u00e1 nguy c\u01a1 m\u1edbi.
\nBan h\u01b0\u1edbng d\u1eabn \u0111\u00e3 c\u00e2n nh\u1eafc li\u1ec7u m\u1ee9c \u0111\u1ed9 nh\u1ea1y th\u1ea5p h\u01a1n 100% c\u00f3 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c hay kh\u00f4ng v\u00e0 k\u1ebft lu\u1eadn r\u1eb1ng m\u1ee5c ti\u00eau \u0111\u1ea1t \u0111\u1ed9 nh\u1ea1y 99% l\u00e0 h\u1ee3p l\u00fd, v\u00ec \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao h\u01a1n \u0111i k\u00e8m v\u1edbi m\u1ee9c gi\u1ea3m nh\u1eb9 v\u1ec1 \u0111\u1ed9 nh\u1ea1y s\u1ebd cho ph\u00e9p nhi\u1ec1u b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n h\u01a1n. Hai c\u00f4ng c\u1ee5 ph\u00e2n t\u1ea7ng nguy c\u01a1 d\u01b0\u1eddng nh\u01b0 \u0111\u1ea1t \u0111\u1ed9 nh\u1ea1y kho\u1ea3ng 99% l\u00e0 GBS = 0-1 v\u00e0 m\u00f4 h\u00ecnh c\u1ee7a Shung. Tuy nhi\u00ean, ban h\u01b0\u1edbng d\u1eabn ch\u1ec9 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn GBS trong khuy\u1ebfn c\u00e1o v\u00ec GBS \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u r\u1ed9ng r\u00e3i trong nhi\u1ec1u b\u1ed1i c\u1ea3nh kh\u00e1c nhau, trong khi m\u00f4 h\u00ecnh c\u1ee7a Shung hi\u1ec7n m\u1edbi ch\u1ec9 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong m\u1ed9t b\u1ed1i c\u1ea3nh.<\/p>\n
$\"B\u1ea3ng$
B\u1ea3ng 2×2 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cho qu\u1ea7n th\u1ec3 gi\u1ea3 \u0111\u1ecbnh g\u1ed3m 250 b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m v\u00ec xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean, s\u1eed d\u1ee5ng ng\u01b0\u1ee1ng \u0111i\u1ec3m Glasgow-Blatchford l\u00e0 1. H\u00e0ng tr\u00ean bao g\u1ed3m nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m 0-1 (\u0111\u01b0\u1ee3c xem l\u00e0 nguy c\u01a1 r\u1ea5t th\u1ea5p). C\u1ed9t b\u00ean tr\u00e1i th\u1ec3 hi\u1ec7n 100 b\u1ec7nh nh\u00e2n s\u1ebd c\u1ea7n can thi\u1ec7p t\u1ea1i b\u1ec7nh vi\u1ec7n ho\u1eb7c t\u1ee7 vong, trong \u0111\u00f3 \u0111\u1ed9 nh\u1ea1y \u0111\u01b0\u1ee3c t\u00ednh theo c\u00f4ng th\u1ee9c: s\u1ed1 d\u01b0\u01a1ng t\u00ednh th\u1eadt chia cho t\u1ed5ng s\u1ed1 b\u1ec7nh nh\u00e2n c\u1ea7n can thi\u1ec7p ho\u1eb7c t\u1eed vong (99\/100 = 99%). C\u1ed9t b\u00ean ph\u1ea3i th\u1ec3 hi\u1ec7n 150 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u1ea7n can thi\u1ec7p t\u1ea1i b\u1ec7nh vi\u1ec7n ho\u1eb7c kh\u00f4ng t\u1eed vong, trong \u0111\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u \u0111\u01b0\u1ee3c t\u00ednh theo c\u00f4ng th\u1ee9c: s\u1ed1 \u00e2m t\u00ednh th\u1eadt chia cho t\u1ed5ng s\u1ed1 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u1ea7n can thi\u1ec7p ho\u1eb7c kh\u00f4ng t\u1eed vong (50\/150 = 33%)<\/figcaption><\/figure>\n
\u0110i\u1ec1u quan tr\u1ecdng l\u00e0 ng\u01b0\u1ee1ng \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t v\u1edbi t\u1ef7 l\u1ec7 \u00e2m t\u00ednh gi\u1ea3 1% (t\u01b0\u01a1ng \u1ee9ng v\u1edbi \u0111\u1ed9 nh\u1ea1y 99%) cho k\u1ebft c\u1ee5c c\u1ea7n can thi\u1ec7p t\u1ea1i b\u1ec7nh vi\u1ec7n ho\u1eb7c t\u1eed vong \u0111\u00f3ng vai tr\u00f2 nh\u01b0 m\u1ed9t \u0111\u1ecbnh h\u01b0\u1edbng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c m\u00f4 h\u00ecnh ti\u00ean l\u01b0\u1ee3ng s\u1ebd \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n trong t\u01b0\u01a1ng lai. Nguy\u1ec7n v\u1ecdng b\u1ec7nh nh\u00e2n v\u00e0 b\u00e1c s\u0129 li\u00ean quan \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 ch\u1eafc ch\u1eafn v\u1ec1 nguy c\u01a1 v\u00e0 mong mu\u1ed1n \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa so v\u1edbi n\u1ed9i tr\u00fa n\u00ean \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c quy\u1ebft \u0111\u1ecbnh c\u00e1c ng\u01b0\u1ee1ng n\u00e0y. C\u00e1c quy\u1ebft \u0111\u1ecbnh c\u1ea7n \u0111\u01b0\u1ee3c c\u00e1 th\u1ec3 h\u00f3a d\u1ef1a tr\u00ean tu\u1ed5i b\u1ec7nh nh\u00e2n, b\u1ec7nh k\u00e8m, \u0111\u1ed9 tin c\u1eady, kh\u1ea3 n\u0103ng ti\u1ebfp c\u1eadn c\u01a1 s\u1edf y t\u1ebf sau khi xu\u1ea5t vi\u1ec7n.<\/p>\n
M\u1eb7c d\u00f9 c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t cho th\u1ea5y \u0111i\u1ec3m GBS v\u00e0 m\u00f4 h\u00ecnh c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n nguy c\u01a1 r\u1ea5t th\u1ea5p v\u1edbi \u0111\u1ed9 nh\u1ea1y cao, nh\u01b0ng b\u1eb1ng ch\u1ee9ng c\u00f2n h\u1ea1n ch\u1ebf \u0111\u1ec3 ch\u1ee9ng minh r\u1eb1ng vi\u1ec7c cho nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y xu\u1ea5t vi\u1ec7n t\u1eeb khoa c\u1ea5p c\u1ee9u v\u00e0 qu\u1ea3n l\u00fd ngo\u1ea1i tr\u00fa th\u1ef1c s\u1ef1 an to\u00e0n, v\u1edbi r\u1ea5t \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 nguy c\u01a1, so v\u1edbi vi\u1ec7c nh\u1eadp vi\u1ec7n. Ch\u1ec9 c\u00f3 1 nghi\u00ean c\u1ee9u \u0111\u00e1p \u1ee9ng ti\u00eau ch\u00ed c\u1ee7a PICO n\u00e0y \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. Tr\u01b0\u1edbc khi \u00e1p d\u1ee5ng quy t\u1eafc r\u1eb1ng b\u1ec7nh nh\u00e2n c\u00f3 GBS = 0 s\u1ebd kh\u00f4ng nh\u1eadp vi\u1ec7n tr\u1eeb khi c\u00f3 l\u00fd do kh\u00e1c, kh\u00f4ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p n\u00e0o trong s\u1ed1 105 b\u1ec7nh nh\u00e2n c\u00f3 GBS = 0 c\u1ea7n can thi\u1ec7p t\u1ea1i b\u1ec7nh vi\u1ec7n (truy\u1ec1n m\u00e1u, n\u1ed9i soi ho\u1eb7c ph\u1eabu thu\u1eadt) ho\u1eb7c t\u1eed vong trong v\u00f2ng 30 ng\u00e0y. Sau khi \u00e1p d\u1ee5ng quy t\u1eafc n\u00e0y, c\u0169ng kh\u00f4ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p n\u00e0o trong 84 b\u1ec7nh nh\u00e2n c\u00f3 GBS = 0 kh\u00f4ng nh\u1eadp vi\u1ec7n c\u1ea7n can thi\u1ec7p t\u1ea1i b\u1ec7nh vi\u1ec7n ho\u1eb7c t\u1eed vong trong th\u1eddi gian theo d\u00f5i. Ngo\u00e0i ra, m\u1ed9t lo\u1ea1t ca h\u1ed3i c\u1ee9u ghi nh\u1eadn r\u1eb1ng sau khi tri\u1ec3n khai m\u1ed9t quy tr\u00ecnh trong \u0111\u00f3 nh\u1eefng b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean c\u1ea5p c\u00f3 GBS = 0-1 s\u1ebd \u0111\u01b0\u1ee3c cho xu\u1ea5t vi\u1ec7n t\u1eeb khoa c\u1ea5p c\u1ee9u v\u00e0 theo d\u00f5i ngo\u1ea1i tr\u00fa n\u1ebfu kh\u00f4ng c\u00f3 l\u00fd do kh\u00e1c \u0111\u1ec3 nh\u1eadp vi\u1ec7n, th\u00ec kh\u00f4ng c\u00f3 b\u1ec7nh nh\u00e2n n\u00e0o trong s\u1ed1 103 ng\u01b0\u1eddi c\u00f3 GBS = 0-1 \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n c\u1ea7n can thi\u1ec7p t\u1ea1i b\u1ec7nh vi\u1ec7n ho\u1eb7c t\u1eed vong trong v\u00f2ng 30 ng\u00e0y.<\/p>\n
K\u1ebft lu\u1eadn<\/h4>\n
Vi\u1ec7c s\u1eed d\u1ee5ng c\u00f4ng c\u1ee5 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 \u2264 1% c\u1ea7n truy\u1ec1n m\u00e1u, can thi\u1ec7p c\u1ea7m m\u00e1u ho\u1eb7c t\u1eed vong – nh\u1eefng ng\u01b0\u1eddi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c cho xu\u1ea5t vi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa – s\u1ebd gi\u00fap gi\u1ea3m s\u1ed1 ca nh\u1eadp vi\u1ec7n v\u00e0 chi ph\u00ed. \u0110i\u1ec3m Glasgow-Blatchford 0-1 \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c ti\u00eau ch\u00ed n\u00e0y v\u00e0 cho ph\u00e9p nhi\u1ec1u b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n h\u01a1n so v\u1edbi ng\u01b0\u1eddng GBS = 0, v\u1ed1n l\u00e0 ng\u01b0\u1ee1ng \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t trong h\u01b0\u1edbng d\u1eabn ACG n\u0103m 2012.<\/p>\n
Truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u<\/h3>\n
Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t chi\u1ebfn l\u01b0\u1ee3c truy\u1ec1n h\u1ed3ng c\u1ea7u h\u1ea1n ch\u1ebf, v\u1edbi ng\u01b0\u1ee1ng truy\u1ec1n khi hemoglobin l\u00e0 7 g\/dL \u1edf b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng th\u1ea5p).<\/strong><\/p>\n
T\u00f3m t\u1eaft b\u1eb1ng ch\u1ee9ng<\/h4>\n
\u0110\u1ed1i v\u1edbi d\u00e2n s\u1ed1 chung b\u1ecb thi\u1ebfu m\u00e1u (kh\u00f4ng ch\u1ec9 ri\u00eang UGIB), c\u00e1c h\u01b0\u1edbng d\u1eabn hi\u1ec7n h\u00e0nh t\u1ea1i Hoa K\u1ef3 \u0111\u01b0a ra khuy\u1ebfn c\u00e1o m\u1ea1nh v\u1ec1 ng\u01b0\u1ee1ng truy\u1ec1n h\u1ed3ng c\u1ea7u h\u1ea1n ch\u1ebf l\u00e0 7 g\/dL \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh, bao g\u1ed3m c\u1ea3 b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c, v\u00e0 ng\u01b0\u1ee1ng 8 g\/dL \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang tr\u1ea3i qua ph\u1eabu thu\u1eadt ch\u1ec9nh h\u00ecnh ho\u1eb7c tim m\u1ea1ch, c\u0169ng nh\u01b0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 b\u1ec7nh tim m\u1ea1ch t\u1eeb tr\u01b0\u1edbc. Khuy\u1ebfn c\u00e1o n\u00e0y cho r\u1eb1ng ng\u01b0\u1ee1ng 7 g\/dL c\u00f3 kh\u1ea3 n\u0103ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi 8 g\/dL, nh\u01b0ng ch\u01b0a c\u00f3 \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean \u1edf t\u1ea5t c\u1ea3 c\u00e1c nh\u00f3m b\u1ec7nh nh\u00e2n; \u0111\u1eb7c bi\u1ec7t, b\u1eb1ng ch\u1ee9ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u00e0 ch\u01b0a \u0111\u1ee7 \u0111\u1ec3 \u0111\u01b0a ra khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p. C\u00e1c khuy\u1ebfn c\u00e1o n\u00e0y d\u1ef1a tr\u00ean m\u1ed9t t\u1ed5ng quan h\u1ec7 th\u1ed1ng cho th\u1ea5y c\u00e1c chi\u1ebfn l\u01b0\u1ee3c truy\u1ec1n m\u00e1u h\u1ea1n ch\u1ebf gi\u00fap gi\u1ea3m 43% s\u1ed1 b\u1ec7nh nh\u00e2n c\u1ea7n truy\u1ec1n h\u1ed3ng c\u1ea7u, m\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng quan tr\u1ecdng.<\/p>\n
C\u00f3 hai th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng \u0111\u00e1p \u1ee9ng ti\u00eau ch\u00ed \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 chi\u1ebfn l\u01b0\u1ee3c truy\u1ec1n m\u00e1u h\u1ea1n ch\u1ebf so v\u1edbi t\u1ef1 do trong xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean. Villaneuva v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 th\u1ef1c hi\u1ec7n m\u1ed9t nghi\u00ean c\u1ee9u so s\u00e1nh ng\u1eabu nhi\u00ean gi\u1eefa ng\u01b0\u1ee1ng truy\u1ec1n 7 g\/dL v\u00e0 9 g\/dL tr\u00ean 899 b\u1ec7nh nh\u00e2n, v\u1edbi k\u1ebft c\u1ee5c ch\u00ednh l\u00e0 t\u1eed vong sau 45 ng\u00e0y. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ea3y m\u00e1u \u1ed3 \u1ea1t m\u1ea5t m\u00e1u c\u1ea5p v\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 b\u1ec7nh m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean c\u00f3 tri\u1ec7u ch\u1ee9ng, \u0111\u1ed9t qu\u1ef5 ho\u1eb7c c\u01a1n thi\u1ebfu m\u00e1u n\u00e3o tho\u00e1ng qua trong v\u00f2ng 90 ng\u00e0y tr\u01b0\u1edbc \u0111\u00f3 \u0111\u00e3 b\u1ecb lo\u1ea1i tr\u1eeb. Vi\u1ec7c truy\u1ec1n m\u00e1u \u00edt x\u1ea3y ra h\u01a1n \u1edf nh\u00f3m chi\u1ebfn l\u01b0\u1ee3c h\u1ea1n ch\u1ebf (49% so v\u1edbi 86%, p < 0.001). Nh\u00f3m h\u1ea1n ch\u1ebf c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong th\u1ea5p h\u01a1n (5% so v\u1edbi 9%, p = 0.02), \u00edt ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t h\u01a1n (10% so v\u1edbi 16%, p = 0.01) v\u00e0 \u00edt ph\u1ea3n \u1ee9ng truy\u1ec1n m\u00e1u (3% so v\u1edbi 9%, p = 0.001) c\u0169ng nh\u01b0 bi\u1ebfn ch\u1ee9ng tim m\u1ea1ch (11% so v\u1edbi 16%, p = 0.04) h\u01a1n.<\/p>\n
Jairath v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 th\u1ef1c hi\u1ec7n m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean theo c\u1ee5m, trong \u0111\u00f3 c\u00e1c c\u01a1 s\u1edf tham gia \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o c\u00e1c nh\u00e1nh nghi\u00ean c\u1ee9u. Ba b\u1ec7nh vi\u1ec7n \u0111\u01b0\u1ee3c ph\u00e2n v\u00e0o ng\u01b0\u1ee1ng truy\u1ec1n m\u00e1u 8 g\/dL v\u00e0 ba b\u1ec7nh vi\u1ec7n v\u00e0o ng\u01b0\u1ee1ng 10 g\/dL, v\u1edbi ti\u00eau ch\u00ed lo\u1ea1i tr\u1eeb duy nh\u1ea5t l\u00e0 xu\u1ea5t huy\u1ebft m\u1ea5t m\u00e1u \u1ed3 \u1ea1t. S\u1ef1 ph\u00e2n b\u1ed1 kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u gi\u1eefa hai nh\u00f3m nghi\u00ean c\u1ee9u (43% v\u00e0 57%); \u0111\u1ed3ng th\u1eddi c\u0169ng ghi nh\u1eadn kh\u1ea3 n\u0103ng c\u00f3 sai l\u1ec7ch ch\u1ecdn m\u1eabu. S\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c truy\u1ec1n m\u00e1u gi\u1eefa nh\u00f3m h\u1ea1n ch\u1ebf v\u00e0 nh\u00f3m t\u1ef1 do nh\u1ecf h\u01a1n d\u1ef1 ki\u1ebfn (33% so v\u1edbi 46%, p = 0.23), c\u00f3 th\u1ec3 \u00edt nh\u1ea5t m\u1ed9t ph\u1ea7n do m\u1ee9c \u0111\u1ed9 tu\u00e2n th\u1ee7 ch\u00ednh s\u00e1ch truy\u1ec1n m\u00e1u th\u1ea5p h\u01a1n \u1edf nh\u00f3m t\u1ef1 do. Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea gi\u1eefa chi\u1ebfn l\u01b0\u1ee3c h\u1ea1n ch\u1ebf v\u00e0 t\u1ef1 do v\u1ec1 t\u1eed vong trong v\u00f2ng 28 ng\u00e0y (5% so v\u1edbi 7%), ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t (5% so v\u1edbi 9%), ph\u1ea3n \u1ee9ng truy\u1ec1n m\u00e1u (1% so v\u1edbi 2%), ho\u1eb7c c\u00e1c bi\u1ebfn c\u1ed1 huy\u1ebft kh\u1ed1i\/thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 (4% so v\u1edbi 7%).<\/p>\n
D\u1ef1a tr\u00ean c\u00e1c b\u1eb1ng ch\u1ee9ng, h\u01b0\u1edbng d\u1eabn \u0111\u1ec1 xu\u1ea5t chi\u1ebfn l\u01b0\u1ee3c truy\u1ec1n m\u00e1u h\u1ea1n ch\u1ebf. Ng\u01b0\u1ee1ng truy\u1ec1n m\u00e1u \u0111\u01b0\u1ee3c ch\u1ecdn l\u00e0 hemoglobin 7 g\/dL (t\u1ee9c l\u00e0 truy\u1ec1n khi Hb gi\u1ea3m d\u01b0\u1edbi 7 g\/dL), v\u00ec th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean cho th\u1ea5y l\u1ee3i \u00edch c\u1ee7a chi\u1ebfn l\u01b0\u1ee3c h\u1ea1n ch\u1ebf trong UGIB \u0111\u00e3 s\u1eed d\u1ee5ng ng\u01b0\u1ee1ng n\u00e0y. Ngo\u00e0i ra, m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p c\u00e1c RCT \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n m\u00e1u b\u1ea5t k\u1ef3 cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a v\u1ec1 \u1ea3nh h\u01b0\u1edfng l\u00ean t\u1eed vong gi\u1eefa chi\u1ebfn l\u01b0\u1ee3c truy\u1ec1n h\u1ea1n ch\u1ebf v\u00e0 t\u1ef1 do khi so s\u00e1nh nh\u00f3m s\u1eed d\u1ee5ng ng\u01b0\u1ee1ng h\u1ea1n ch\u1ebf 8-9 g\/dL v\u1edbi nh\u00f3m s\u1eed d\u1ee5ng ng\u01b0\u1ee1ng 7 g\/dL. Do c\u00e1c RCT n\u00e0y lo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n UGIB m\u1ea5t m\u00e1u \u1ed3 \u1ea1t v\u00e0 th\u1ef1c t\u1ebf r\u1eb1ng n\u1ed3ng \u0111\u1ed9 hemoglobin \u1edf b\u1ec7nh nh\u00e2n t\u1ee5t huy\u1ebft \u00e1p s\u1ebd gi\u1ea3m th\u00eam sau h\u1ed3i s\u1ee9c d\u1ecbch ngay c\u1ea3 khi kh\u00f4ng c\u00f2n ch\u1ea3y m\u00e1u, h\u01b0\u1edbng d\u1eabn th\u1ed1ng nh\u1ea5t r\u1eb1ng vi\u1ec7c truy\u1ec1n m\u00e1u cho b\u1ec7nh nh\u00e2n t\u1ee5t huy\u1ebft \u00e1p tr\u01b0\u1edbc khi Hb gi\u1ea3m \u0111\u1ebfn 7 g\/dL l\u00e0 h\u1ee3p l\u00fd.<\/p>\n
Do thi\u1ebfu b\u1eb1ng ch\u1ee9ng t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean \u1edf b\u1ec7nh nh\u00e2n UGIB c\u00f3 b\u1ec7nh tim m\u1ea1ch t\u1eeb tr\u01b0\u1edbc, v\u00e0 theo khuy\u1ebfn c\u00e1o hi\u1ec7n h\u00e0nh s\u1eed d\u1ee5ng ng\u01b0\u1ee1ng 8 g\/dL \u1edf nh\u00f3m n\u00e0y, h\u01b0\u1edbng d\u1eabn cho r\u1eb1ng ng\u01b0\u1ee1ng n\u00e0y l\u00e0 h\u1ee3p l\u00fd \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n UGIB c\u00f3 b\u1ec7nh n\u1ec1n tim m\u1ea1ch. C\u1ea7n ph\u00e2n bi\u1ec7t nh\u00f3m n\u00e0y v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p. \u1ede nh\u00f3m sau, b\u1eb1ng ch\u1ee9ng r\u1ea5t h\u1ea1n ch\u1ebf; tuy nhi\u00ean, ph\u00e2n t\u00edch g\u1ed9p t\u1eeb 2 nghi\u00ean c\u1ee9u nh\u1ecf \u1edf b\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u k\u00e8m h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p (N = 141) ho\u1eb7c b\u1ec7nh m\u1ea1ch v\u00e0nh \u1ed5n \u0111\u1ecbnh \u0111\u01b0\u1ee3c can thi\u1ec7p tim m\u1ea1ch (N = 14) cho th\u1ea5y c\u00f3 th\u1ec3 c\u00f3 xu h\u01b0\u1edbng t\u0103ng t\u1eed vong v\u1edbi chi\u1ebfn l\u01b0\u1ee3c truy\u1ec1n m\u00e1u h\u1ea1n ch\u1ebf (ng\u01b0\u1ee1ng 8 g\/dL ho\u1eb7c Hct 24%). Do \u0111\u00f3, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc ng\u01b0\u1ee1ng cao h\u01a1n 8 g\/dL \u1edf b\u1ec7nh nh\u00e2n UGIB k\u00e8m h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p, d\u00f9 b\u1eb1ng ch\u1ee9ng c\u00f2n r\u1ea5t h\u1ea1n ch\u1ebf.<\/p>\n
K\u1ebft lu\u1eadn<\/h4>\n
Chi\u1ebfn l\u01b0\u1ee3c truy\u1ec1n h\u1ed3ng c\u1ea7u h\u1ea1n ch\u1ebf – truy\u1ec1n khi hemoglobin gi\u1ea3m d\u01b0\u1edbi 7 g\/dL – c\u00f3 v\u1ebb gi\u00fap gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t v\u00e0 t\u1eed vong; k\u1ebft lu\u1eadn n\u00e0y kh\u00f4ng thay \u0111\u1ed5i so v\u1edbi h\u01b0\u1edbng d\u1eabn ACG n\u0103m 2012. \u1ede b\u1ec7nh nh\u00e2n t\u1ee5t huy\u1ebft \u00e1p, c\u00f3 th\u1ec3 truy\u1ec1n \u1edf m\u1ee9c hemoglobin cao h\u01a1n do s\u1ef1 c\u00e2n b\u1eb1ng l\u1ea1i sau h\u1ed3i s\u1ee9c d\u1ecbch, v\u00e0 ng\u01b0\u1ee1ng 8 g\/dL l\u00e0 h\u1ee3p l\u00fd \u1edf b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim m\u1ea1ch tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n
\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa tr\u01b0\u1edbc n\u1ed9i soi<\/h3>\n
Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t truy\u1ec1n erythromycin tr\u01b0\u1edbc khi n\u1ed9i soi \u1edf b\u1ec7nh nh\u00e2n UGIB (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p)<\/strong><\/p>\n
T\u00f3m t\u1eaft b\u1eb1ng ch\u1ee9ng<\/h4>\n
C\u01a1 s\u1edf l\u00fd lu\u1eadn c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c t\u0103ng nhu \u0111\u1ed9ng nh\u01b0 erythromycin l\u00e0 gi\u00fap \u0111\u1ea9y m\u00e1u v\u00e0 c\u1ee5c m\u00e1u \u0111\u00f4ng xu\u1ed1ng \u0111o\u1ea1n xa c\u1ee7a \u0111\u01b0\u1eddng ti\u00eau h\u00f3a tr\u00ean, t\u1eeb \u0111\u00f3 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng quan s\u00e1t khi n\u1ed9i soi v\u00e0 n\u00e2ng cao gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n. Vi\u1ec7c t\u0103ng kh\u1ea3 n\u0103ng ch\u1ea9n \u0111o\u00e1n l\u00fd t\u01b0\u1edfng s\u1ebd c\u1ea3i thi\u1ec7n c\u00e1c k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng quan tr\u1ecdng nh\u01b0 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t, nh\u1edd t\u0103ng t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c x\u1eed tr\u00ed ph\u00f9 h\u1ee3p (v\u00ed d\u1ee5: \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa) d\u1ef1a tr\u00ean c\u00e1c ph\u00e1t hi\u1ec7n n\u1ed9i soi. H\u01b0\u1edbng d\u1eabn c\u0169ng x\u00e1c \u0111\u1ecbnh tr\u01b0\u1edbc c\u00e1c l\u1ee3i \u00edch ti\u1ec1m n\u0103ng kh\u00e1c c\u00f3 \u00fd ngh\u0129a: gi\u1ea3m nhu c\u1ea7u n\u1ed9i soi l\u1ea1i (n\u1ebfu ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c h\u01a1n ngay t\u1eeb l\u1ea7n n\u1ed9i soi \u0111\u1ea7u) v\u00e0 gi\u1ea3m th\u1eddi gian n\u1eb1m vi\u1ec7n (do ch\u1ea9n \u0111o\u00e1n s\u1edbm c\u00e1c tr\u01b0\u1eddng h\u1ee3p nguy c\u01a1 th\u1ea5p \u0111\u1ec3 xu\u1ea5t vi\u1ec7n s\u1edbm h\u01a1n, \u0111\u1ed3ng th\u1eddi gi\u1ea3m s\u1ed1 l\u1ea7n n\u1ed9i soi l\u1eb7p l\u1ea1i – y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 k\u00e9o d\u00e0i th\u1eddi gian n\u1eb1m vi\u1ec7n).<\/p>\n
Qu\u00e1 tr\u00ecnh t\u00ecm ki\u1ebfm c\u1ee7a ch\u00fang t\u00f4i x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c m\u1ed9t t\u1ed5ng quan h\u1ec7 th\u1ed1ng g\u1ed3m 8 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u00e0 th\u00eam 1 RCT \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 sau \u0111\u00f3, bao g\u1ed3m 29 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e2n v\u00e0o nh\u00f3m erythromycin ho\u1eb7c r\u1eeda d\u1ea1 d\u00e0y. Ch\u1ec9 c\u00f3 1 trong s\u1ed1 9 RCT n\u00e0y b\u00e1o c\u00e1o k\u1ebft qu\u1ea3 v\u1ec1 ti\u00eau ch\u00ed quan tr\u1ecdng l\u00e0 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t: 1\/14 \u1edf nh\u00f3m erythromycin so v\u1edbi 2\/15 \u1edf nh\u00f3m r\u1eeda d\u1ea1 d\u00e0y; ch\u00eanh l\u1ec7ch -6%. K\u1ebft qu\u1ea3 v\u1ec1 t\u1eed vong \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong 3 RCT; ph\u00e2n t\u00edch g\u1ed9p c\u1ee7a ch\u00fang t\u00f4i cho th\u1ea5y v\u1edbi erythromycin so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c\/kh\u00f4ng \u0111i\u1ec1u tr\u1ecb, RR = 0.81. Ph\u00e2n t\u00edch g\u1ed9p 8 RCT cho th\u1ea5y erythromycin gi\u00fap gi\u1ea3m nhu c\u1ea7u n\u1ed9i soi l\u1ea1i v\u00e0 gi\u1ea3m s\u1ed1 ng\u00e0y n\u1eb1m vi\u1ec7n. S\u1ed1 \u0111\u01a1n v\u1ecb m\u00e1u truy\u1ec1n c\u00f3 xu h\u01b0\u1edbng th\u1ea5p h\u01a1n khi d\u00f9ng erythromycin, tuy nhi\u00ean s\u1ef1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t \u0111\u00e1ng k\u1ec3 gi\u1eefa c\u00e1c nghi\u00ean c\u1ee9u.<\/p>\n
M\u1eb7c d\u00f9 ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y erythromycin gi\u00fap gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t v\u00e0 t\u1eed vong, thu\u1ed1c n\u00e0y v\u1eabn mang l\u1ea1i nh\u1eefng l\u1ee3i \u00edch \u0111\u00e1ng k\u1ec3 nh\u01b0 gi\u1ea3m nhu c\u1ea7u n\u1ed9i soi l\u1eb7p l\u1ea1i v\u00e0 r\u00fat ng\u1eafn th\u1eddi gian n\u1eb1m vi\u1ec7n. L\u1ee3i \u00edch kinh t\u1ebf t\u1eeb vi\u1ec7c gi\u1ea3m s\u1ed1 th\u1ee7 thu\u1eadt v\u00e0 th\u1eddi gian n\u1eb1m vi\u1ec7n, c\u00f9ng v\u1edbi mong mu\u1ed1n c\u1ee7a b\u1ec7nh nh\u00e2n tr\u00e1nh c\u00e1c th\u1ee7 thu\u1eadt v\u00e0 ng\u00e0y n\u1eb1m vi\u1ec7n, chi ph\u00ed t\u01b0\u01a1ng \u0111\u1ed1i th\u1ea5p v\u00e0 d\u1ec5 s\u1eed d\u1ee5ng, \u0111\u00e3 khi\u1ebfn ban h\u01b0\u1edbng d\u1eabn \u0111\u01b0a ra khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng erythromycin tr\u01b0\u1edbc n\u1ed9i soi. C\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3 kh\u00f4ng cho th\u1ea5y l\u1ee3i \u00edch ch\u1ec9 gi\u1edbi h\u1ea1n \u1edf m\u1ed9t nh\u00f3m b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3 n\u00e0o trong UGIB c\u1ea5p. B\u1eb1ng ch\u1ee9ng v\u1ec1 thu\u1ed1c t\u0103ng nhu \u0111\u1ed9ng kh\u00e1c nh\u01b0 metoclopramide c\u00f2n r\u1ea5t h\u1ea1n ch\u1ebf, ch\u1ee7 y\u1ebfu t\u1eeb c\u00e1c t\u00f3m t\u1eaft nghi\u00ean c\u1ee9u c\u0169, v\u00e0 kh\u00f4ng \u1ee7ng h\u1ed9 cho vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y.<\/p>\n
Li\u1ec1u khuy\u1ebfn c\u00e1o l\u00e0 truy\u1ec1n t\u0129nh m\u1ea1ch 250 mg, v\u00ec \u0111\u00e2y l\u00e0 li\u1ec1u \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t trong c\u00e1c RCT. Thu\u1ed1c \u0111\u01b0\u1ee3c truy\u1ec1n trong 5-30 ph\u00fat (th\u01b0\u1eddng l\u00e0 20-30 ph\u00fat), sau \u0111\u00f3 ti\u1ebfn h\u00e0nh n\u1ed9i soi trong v\u00f2ng 20-90 ph\u00fat. Erythromycin \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch c\u00f3 th\u1ec3 k\u00e9o d\u00e0i kho\u1ea3ng QT, v\u1edbi m\u1ee9c \u0111\u1ed9 \u1ea3nh h\u01b0\u1edfng li\u00ean quan \u0111\u1ebfn t\u1ed1c \u0111\u1ed9 truy\u1ec1n v\u00e0 li\u1ec1u d\u00f9ng, v\u00e0 r\u1ea5t hi\u1ebfm khi g\u00e2y r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t nh\u01b0 xo\u1eafn \u0111\u1ec9nh. Tuy nhi\u00ean, t\u1ed5ng quan c\u00e1c b\u00e1o c\u00e1o ca b\u1ec7nh cho th\u1ea5y bi\u1ebfn c\u1ed1 n\u00e0y ch\u1ee7 y\u1ebfu x\u1ea3y ra khi d\u00f9ng li\u1ec1u cao h\u01a1n v\u00e0\/ho\u1eb7c l\u1eb7p l\u1ea1i nhi\u1ec1u l\u1ea7n. D\u00f9 v\u1eady, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng xo\u1eafn \u0111\u1ec9nh, bao g\u1ed3m k\u00e9o d\u00e0i QT tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, b\u1ec7nh tim, r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan, d\u00f9ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp, v\u00e0 c\u00e1c thu\u1ed1c k\u00e9o d\u00e0i QT l\u00e0 c\u01a1 ch\u1ea5t c\u1ee7a CYP3A4 (v\u00ed d\u1ee5: terfenadine, astemizole).<\/p>\n
K\u1ebft lu\u1eadn<\/h4>\n
Truy\u1ec1n t\u0129nh m\u1ea1ch 250 mg erythromycin trong v\u00f2ng 20-90 ph\u00fat tr\u01b0\u1edbc n\u1ed9i soi c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m nhu c\u1ea7u n\u1ed9i soi l\u1eb7p l\u1ea1i v\u00e0 r\u00fat ng\u1eafn th\u1eddi gian n\u1eb1m vi\u1ec7n, m\u1eb7c d\u00f9 ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng nh\u01b0 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t. H\u01b0\u1edbng d\u1eabn ACG n\u0103m 2012 \u0111\u00e3 n\u00eau r\u1eb1ng vi\u1ec7c truy\u1ec1n thu\u1ed1c n\u00e0y \u201cn\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc\u201d.<\/p>\n
Ch\u00fang t\u00f4i ch\u01b0a th\u1ec3 \u0111\u01b0a ra khuy\u1ebfn c\u00e1o \u1ee7ng h\u1ed9 hay ph\u1ea3n \u0111\u1ed1i vi\u1ec7c s\u1eed d\u1ee5ng PPI tr\u01b0\u1edbc n\u1ed9i soi \u1edf b\u1ec7nh nh\u00e2n UGIB<\/strong><\/p>\n
T\u00f3m t\u1eaft b\u1eb1ng ch\u1ee9ng<\/h4>\n
T\u1ed5ng quan h\u1ec7 th\u1ed1ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c 3 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 vi\u1ec7c s\u1eed d\u1ee5ng PPI tr\u01b0\u1edbc n\u1ed9i soi. Tuy nhi\u00ean, trong 2 nghi\u00ean c\u1ee9u n\u00e0y, t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n v\u1eabn ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb theo nh\u00f3m ban \u0111\u1ea7u (gi\u1ea3 d\u01b0\u1ee3c ho\u1eb7c PPI) sau khi n\u1ed9i soi. Do th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng hi\u1ec7n nay y\u00eau c\u1ea7u s\u1eed d\u1ee5ng PPI \u1edf b\u1ec7nh nh\u00e2n lo\u00e9t, n\u00ean 2 nghi\u00ean c\u1ee9u n\u00e0y kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi th\u1ef1c h\u00e0nh hi\u1ec7n t\u1ea1i. Thi\u1ebft k\u1ebf n\u00e0y c\u0169ng c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p lu\u1eadn, v\u00ec n\u1ebfu b\u1ec7nh nh\u00e2n trong nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c c\u1ea7n PPI nh\u01b0ng v\u1eabn ti\u1ebfp t\u1ee5c d\u00f9ng gi\u1ea3 d\u01b0\u1ee3c sau n\u1ed9i soi, trong khi nh\u00f3m PPI ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c d\u00f9ng PPI, th\u00ec s\u1ebd t\u1ea1o ra sai l\u1ec7ch c\u00f3 l\u1ee3i cho nh\u00f3m PPI. Do \u0111\u00f3, hai nghi\u00ean c\u1ee9u n\u00e0y kh\u00f4ng cho ph\u00e9p \u0111\u00e1nh gi\u00e1 c\u00e1c k\u1ebft c\u1ee5c sau n\u1ed9i soi nh\u01b0 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t v\u00e0 t\u1eed vong, n\u00ean h\u01b0\u1edbng d\u1eabn ch\u1ec9 d\u1ef1a v\u00e0o nghi\u00ean c\u1ee9u c\u1ee7a Lau v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c k\u1ebft c\u1ee5c n\u00e0y. C\u1ea3 3 nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c k\u1ebft c\u1ee5c tr\u01b0\u1edbc th\u1eddi \u0111i\u1ec3m n\u1ed9i soi, ch\u1eb3ng h\u1ea1n nh\u01b0 nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi.<\/p>\n
Lau v\u00e0 c\u1ed9ng s\u1ef1 kh\u00f4ng t\u00ecm th\u1ea5y b\u1eb1ng ch\u1ee9ng cho th\u1ea5y l\u1ee3i \u00edch c\u1ee7a PPI (omeprazole \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, bolus 80 mg sau \u0111\u00f3 truy\u1ec1n 8 mg\/gi\u1edd) so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c trong vi\u1ec7c gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t ho\u1eb7c t\u1eed vong. T\u01b0\u01a1ng t\u1ef1, ph\u00e2n t\u00edch g\u1ed9p c\u1ee7a ch\u00fang t\u00f4i t\u1eeb 2 nghi\u00ean c\u1ee9u kh\u00e1c b\u1ecb lo\u1ea1i tr\u1eeb c\u0169ng kh\u00f4ng cho th\u1ea5y l\u1ee3i \u00edch v\u1ec1 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t ho\u1eb7c t\u1eed vong, m\u1eb7c d\u00f9 c\u00f3 xu h\u01b0\u1edbng thi\u00ean l\u1ec7ch c\u00f3 l\u1ee3i cho PPI. Tuy nhi\u00ean, ph\u00e2n t\u00edch g\u1ed9p c\u1ee7a c\u1ea3 3 nghi\u00ean c\u1ee9u cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng PPI so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c gi\u00fap gi\u1ea3m nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb c\u1ea7m m\u00e1u n\u1ed9i soi trong l\u1ea7n n\u1ed9i soi ban \u0111\u1ea7u.<\/p>\n
Do \u0111\u00f3, c\u00e1c b\u1eb1ng ch\u1ee9ng h\u1ea1n ch\u1ebf v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng th\u1ea5p cho th\u1ea5y kh\u00f4ng c\u00f3 l\u1ee3i \u00edch r\u00f5 r\u00e0ng c\u1ee7a vi\u1ec7c d\u00f9ng PPI tr\u01b0\u1edbc n\u1ed9i soi \u0111\u1ed1i v\u1edbi t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u ti\u1ebfp di\u1ec5n ho\u1eb7c t\u1eed vong, m\u1eb7c d\u00f9 c\u00e1c kho\u1ea3ng tin c\u1eady cho nh\u1eefng k\u1ebft c\u1ee5c n\u00e0y c\u00f2n r\u1ed9ng. Trong b\u1ed1i c\u1ea3nh thi\u1ebfu b\u1eb1ng ch\u1ee9ng v\u1ec1 l\u1ee3i \u00edch l\u00e2m s\u00e0ng, h\u1ed9i \u0111\u1ed3ng chuy\u00ean gia kh\u00f4ng th\u1ec3 \u0111\u01b0a ra khuy\u1ebfn c\u00e1o ch\u1ed1ng l\u1ea1i vi\u1ec7c s\u1eed d\u1ee5ng PPI tr\u01b0\u1edbc n\u1ed9i soi. Tuy nhi\u00ean, h\u1ed9i \u0111\u1ed3ng c\u0169ng kh\u00f4ng khuy\u1ebfn c\u00e1o ch\u1ed1ng l\u1ea1i vi\u1ec7c d\u00f9ng PPI tr\u01b0\u1edbc n\u1ed9i soi, do b\u1eb1ng ch\u1ee9ng c\u00f2n thi\u1ebfu ch\u00ednh x\u00e1c v\u00e0 c\u00f3 th\u00eam c\u00e1c d\u1eef li\u1ec7u gi\u00e1n ti\u1ebfp kh\u00e1c. D\u1eef li\u1ec7u t\u1eeb th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean cho th\u1ea5y li\u1ec7u ph\u00e1p PPI li\u1ec1u cao sau n\u1ed9i soi gi\u00fap gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t sau can thi\u1ec7p n\u1ed9i soi \u1edf b\u1ec7nh nh\u00e2n c\u00f3 lo\u00e9t v\u1edbi d\u1ea5u hi\u1ec7u nguy c\u01a1 cao, c\u0169ng nh\u01b0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 c\u1ee5c m\u00e1u \u0111\u00f4ng b\u00e1m d\u00ednh nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi. \u0110i\u1ec1u n\u00e0y g\u1ee3i \u00fd r\u1eb1ng PPI tr\u01b0\u1edbc n\u1ed9i soi c\u00f3 th\u1ec3 mang l\u1ea1i m\u1ed9t s\u1ed1 l\u1ee3i \u00edch cho m\u1ed9t nh\u00f3m nh\u1ecf b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean. Ngo\u00e0i ra, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c n\u1ed9i soi ho\u1eb7c \u0111i\u1ec1u tr\u1ecb c\u1ea7m m\u00e1u n\u1ed9i soi, ho\u1eb7c b\u1ecb tr\u00ec ho\u00e3n, h\u1ed9i \u0111\u1ed3ng cho r\u1eb1ng c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc d\u00f9ng PPI tr\u01b0\u1edbc n\u1ed9i soi d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng r\u1ea5t gi\u00e1n ti\u1ebfp t\u1eeb m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean. Ph\u00e2n t\u00edch n\u00e0y cho th\u1ea5y gi\u1ea3m nguy c\u01a1 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t, nh\u01b0ng kh\u00f4ng gi\u1ea3m t\u1eed vong, khi so s\u00e1nh PPI v\u1edbi gi\u1ea3 d\u01b0\u1ee3c ho\u1eb7c thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 H2.<\/p>\n
Vi\u1ec7c d\u00f9ng PPI tr\u01b0\u1edbc n\u1ed9i soi c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m nh\u1eb9 nhu c\u1ea7u can thi\u1ec7p n\u1ed9i soi. Nh\u1eefng b\u00e1c s\u0129 v\u00e0 b\u1ec7nh nh\u00e2n coi tr\u1ecdng vi\u1ec7c gi\u1ea3m nhu c\u1ea7u can thi\u1ec7p n\u00e0y c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn s\u1eed d\u1ee5ng PPI tr\u01b0\u1edbc n\u1ed9i soi. C\u00e1c y\u1ebfu t\u1ed1 kinh t\u1ebf c\u0169ng kh\u00e1c nhau t\u00f9y t\u1eebng h\u1ec7 th\u1ed1ng y t\u1ebf: chi ph\u00ed t\u0103ng th\u00eam khi d\u00f9ng PPI cho t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean so v\u1edbi kho\u1ea3n ti\u1ebft ki\u1ec7m nh\u1edd tr\u00e1nh \u0111\u01b0\u1ee3c n\u1ed9i soi \u1edf m\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn quy\u1ebft \u0111\u1ecbnh.<\/p>\n
K\u1ebft lu\u1eadn<\/h4>\n
C\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3 cho th\u1ea5y kh\u00f4ng c\u00f3 l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c d\u00f9ng PPI tr\u01b0\u1edbc n\u1ed9i soi \u0111\u1ed1i v\u1edbi c\u00e1c k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng, do \u0111\u00f3 kh\u00f4ng th\u1ec3 \u0111\u01b0a ra khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng. Tuy nhi\u00ean, do c\u00f3 gi\u1ea3m nh\u1eb9 nhu c\u1ea7u can thi\u1ec7p n\u1ed9i soi, c\u00f9ng v\u1edbi kh\u1ea3 n\u0103ng ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u1eb1ng PPI c\u00f3 th\u1ec3 mang l\u1ea1i l\u1ee3i \u00edch cho m\u1ed9t nh\u00f3m nh\u1ecf b\u1ec7nh nh\u00e2n v\u00e0\/ho\u1eb7c nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n n\u1ed9i soi ho\u1eb7c b\u1ecb tr\u00ec ho\u00e3n, ch\u00fang t\u00f4i kh\u00f4ng khuy\u1ebfn c\u00e1o ch\u1ed1ng l\u1ea1i vi\u1ec7c s\u1eed d\u1ee5ng. C\u00e1c h\u01b0\u1edbng d\u1eabn kh\u00e1c \u0111\u01b0a ra quan \u0111i\u1ec3m r\u1ea5t kh\u00e1c nhau, t\u1eeb khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng \u0111\u1ebfn khuy\u1ebfn c\u00e1o kh\u00f4ng s\u1eed d\u1ee5ng PPI tr\u01b0\u1edbc n\u1ed9i soi. Trong c\u00e1c h\u01b0\u1edbng d\u1eabn tr\u01b0\u1edbc \u0111\u00e2y, ch\u00fang t\u00f4i cho r\u1eb1ng PPI tr\u01b0\u1edbc n\u1ed9i soi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111\u1ec3 gi\u1ea3m nhu c\u1ea7u can thi\u1ec7p n\u1ed9i soi nh\u01b0ng kh\u00f4ng c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng. C\u00e1c h\u01b0\u1edbng d\u1eabn n\u00ean \u0111\u01b0a ra m\u1ed9t h\u00e0nh \u0111\u1ed9ng khuy\u1ebfn c\u00e1o c\u1ee5 th\u1ec3. Do \u0111\u00f3, nh\u1eefng c\u00e1ch di\u1ec5n \u0111\u1ea1t nh\u01b0 \u201cc\u00f3 th\u1ec3 c\u00e2n nh\u1eafc\u201d v\u1ed1n kh\u00f4ng nghi\u00eang v\u1ec1 khuy\u1ebfn c\u00e1o hay kh\u00f4ng s\u1eed d\u1ee5ng (v\u00ed d\u1ee5 nh\u01b0 d\u00f9ng PPI), hi\u1ec7n kh\u00f4ng c\u00f2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng.<\/p>\n
N\u1ed9i soi trong xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean<\/h3>\n
Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n ho\u1eb7c \u0111ang \u0111\u01b0\u1ee3c theo d\u00f5i t\u1ea1i b\u1ec7nh vi\u1ec7n v\u00ec UGIB n\u00ean \u0111\u01b0\u1ee3c n\u1ed9i soi trong v\u00f2ng 24 gi\u1edd k\u1ec3 t\u1eeb khi nh\u1eadp vi\u1ec7n (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p)<\/strong><\/p>\n
T\u00f3m t\u1eaft b\u1eb1ng ch\u1ee9ng<\/h4>\n
Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 l\u00e0 l\u00fd do cho n\u1ed9i soi s\u1edbm; c\u1ea7n c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y l\u1ee3i \u00edch v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng, kinh t\u1ebf ho\u1eb7c c\u00e1c k\u1ebft c\u1ee5c h\u01b0\u1edbng \u0111\u1ebfn b\u1ec7nh nh\u00e2n. Nh\u1eefng l\u1ee3i \u00edch ti\u1ec1m n\u0103ng c\u1ee7a n\u1ed9i soi s\u1edbm bao g\u1ed3m \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng ch\u00ednh x\u00e1c h\u01a1n \u0111\u1ec3 \u0111\u1ecbnh h\u01b0\u1edbng x\u1eed tr\u00ed (v\u00ed d\u1ee5: th\u1eddi \u0111i\u1ec3m cho \u0103n l\u1ea1i v\u00e0 xu\u1ea5t vi\u1ec7n) v\u00e0 tri\u1ec3n khai s\u1edbm \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi ho\u1eb7c n\u1ed9i khoa d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 n\u1ed9i soi. Nh\u1eefng nguy c\u01a1 ti\u1ec1m t\u00e0ng c\u00f3 th\u1ec3 bao g\u1ed3m t\u1eed vong ho\u1eb7c bi\u1ebfn ch\u1ee9ng n\u1ebfu n\u1ed9i soi \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u01b0\u1edbc khi h\u1ed3i s\u1ee9c th\u00edch h\u1ee3p v\u00e0 ki\u1ec3m so\u00e1t c\u00e1c b\u1ec7nh \u0111i k\u00e8m \u0111ang ho\u1ea1t \u0111\u1ed9ng, c\u0169ng nh\u01b0 k\u1ebft c\u1ee5c k\u00e9m h\u01a1n khi n\u1ed9i soi ngo\u00e0i gi\u1edd h\u00e0nh ch\u00ednh. Khuy\u1ebfn c\u00e1o n\u00e0y ch\u1ec9 \u00e1p d\u1ee5ng cho b\u1ec7nh nh\u00e2n \u0111\u00e3 nh\u1eadp vi\u1ec7n ho\u1eb7c \u0111ang \u0111\u01b0\u1ee3c theo d\u00f5i t\u1ea1i b\u1ec7nh vi\u1ec7n. Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 nguy c\u01a1 r\u1ea5t th\u1ea5p v\u00e0 \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n t\u1eeb khoa c\u1ea5p c\u1ee9u v\u1edbi k\u1ebf ho\u1ea1ch theo d\u00f5i ngo\u1ea1i tr\u00fa kh\u00f4ng \u0111\u01b0\u1ee3c xem x\u00e9t. C\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o do thi\u1ebfu RCT tr\u1ef1c ti\u1ebfp tr\u1ea3 l\u1eddi c\u00e2u h\u1ecfi nghi\u00ean c\u1ee9u. V\u00ec c\u00f3 th\u1ec3 t\u1ed3n t\u1ea1i nh\u1eefng kh\u00e1c bi\u1ec7t c\u01a1 b\u1ea3n v\u1ec1 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m quan tr\u1ecdng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft c\u1ee5c gi\u1eefa nh\u00f3m \u0111\u01b0\u1ee3c n\u1ed9i soi s\u1edbm v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c n\u1ed9i soi s\u1edbm trong c\u00e1c nghi\u00ean c\u1ee9u kh\u00f4ng ng\u1eabu nhi\u00ean, n\u00ean ch\u1ec9 nh\u1eefng nghi\u00ean c\u1ee9u quan s\u00e1t c\u00f3 \u0111i\u1ec1u ch\u1ec9nh th\u1ed1ng k\u00ea \u0111\u1ea7y \u0111\u1ee7 trong \u0111\u00e1nh gi\u00e1 k\u1ebft c\u1ee5c m\u1edbi \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ph\u00e2n t\u00edch.<\/p>\n
Qu\u1ea7n th\u1ec3 chung b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean. Kh\u00f4ng c\u00f3 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng n\u00e0o \u0111\u00e1nh gi\u00e1 n\u1ed9i soi trong v\u00f2ng 24 gi\u1edd so v\u1edbi sau 24 gi\u1edd. Tuy nhi\u00ean, c\u00f3 m\u1ed9t RCT so s\u00e1nh n\u1ed9i soi th\u1ef1c hi\u1ec7n \u2264 12 gi\u1edd so v\u1edbi > 12 gi\u1edd sau khi b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m \u1edf c\u00e1c b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean. T\u00e1c gi\u1ea3 ch\u1ec9 b\u00e1o c\u00e1o k\u1ebft qu\u1ea3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ea3y m\u00e1u do lo\u00e9t \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn qua n\u1ed9i soi, v\u00e0 nh\u1eadn th\u1ea5y kh\u00f4ng gi\u1ea3m t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t ho\u1eb7c t\u1eed vong. B\u1eb1ng ch\u1ee9ng ch\u1ea5t l\u01b0\u1ee3ng r\u1ea5t th\u1ea5p t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t cho th\u1ea5y nh\u1eefng b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u00ec xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean v\u00e0 \u0111\u01b0\u1ee3c n\u1ed9i soi trong v\u00f2ng 1 ng\u00e0y sau nh\u1eadp vi\u1ec7n c\u00f3 th\u1eddi gian n\u1eb1m vi\u1ec7n ng\u1eafn h\u01a1n so v\u1edbi nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng \u0111\u01b0\u1ee3c n\u1ed9i soi s\u1edbm. Hai trong s\u1ed1 c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t n\u00e0y c\u00f2n ghi nh\u1eadn nguy c\u01a1 ph\u1ea3i ph\u1eabu thu\u1eadt th\u1ea5p h\u01a1n, v\u00e0 m\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c b\u00e1o c\u00e1o gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong khi n\u1ed9i soi trong v\u00f2ng 1 ng\u00e0y sau nh\u1eadp vi\u1ec7n. Tuy nhi\u00ean, v\u1eabn ch\u01b0a ch\u1eafc ch\u1eafn li\u1ec7u n\u1ed9i soi \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 \u201ctrong v\u00f2ng 1 ng\u00e0y sau nh\u1eadp vi\u1ec7n\u201d trong c\u00e1c nghi\u00ean c\u1ee9u s\u1eed d\u1ee5ng d\u1eef li\u1ec7u c\u01a1 s\u1edf c\u00f3 th\u1ef1c s\u1ef1 di\u1ec5n ra trong v\u00f2ng 24 gi\u1edd hay kh\u00f4ng; m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00e0o ng\u00e0y ti\u1ebfp theo, t\u1ee9c l\u00e0 sau h\u01a1n 24 gi\u1edd k\u1ec3 t\u1eeb khi nh\u1eadp vi\u1ec7n.<\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng nguy c\u01a1 th\u1ea5p. Hai th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng nh\u1ecf tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng nguy c\u01a1 th\u1ea5p (huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh, kh\u00f4ng c\u00f3 b\u1ec7nh n\u1eb7ng \u0111i k\u00e8m) cho th\u1ea5y n\u1ed9i soi trong v\u00f2ng 2-6 gi\u1edd sau \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u gi\u00fap ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng nguy c\u01a1 th\u1ea5p tr\u00ean n\u1ed9i soi (v\u00ed d\u1ee5: lo\u00e9t \u0111\u00e1y s\u1ea1ch, Mallory-Weiss). Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y cho ph\u00e9p xu\u1ea5t vi\u1ec7n v\u00e0 theo d\u00f5i ngo\u1ea1i tr\u00fa \u1edf \u00edt nh\u1ea5t 40% b\u1ec7nh nh\u00e2n. Vi\u1ec7c gi\u1ea3m nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa ch\u1ec9 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf m\u1ed9t trong hai nghi\u00ean c\u1ee9u, do \u1edf nghi\u00ean c\u1ee9u c\u00f2n l\u1ea1i, c\u00e1c b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb kh\u00f4ng tu\u00e2n theo khuy\u1ebfn c\u00e1o c\u1ee7a b\u00e1c s\u0129 n\u1ed9i soi v\u1ec1 vi\u1ec7c cho xu\u1ea5t vi\u1ec7n v\u00e0 theo d\u00f5i ngo\u1ea1i tr\u00fa \u1edf kho\u1ea3ng 80% b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng nguy c\u01a1 th\u1ea5p. Kh\u00f4ng ghi nh\u1eadn s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t ho\u1eb7c t\u1eed vong gi\u1eefa c\u00e1c nh\u00f3m. Do kh\u00f4ng c\u00f3 RCT n\u00e0o so s\u00e1nh n\u1ed9i soi trong v\u00f2ng 24 gi\u1edd v\u1edbi sau 24 gi\u1edd, c\u00e1c t\u00e1c gi\u1ea3 c\u0169ng xem x\u00e9t m\u1ed9t nghi\u00ean c\u1ee9u thu\u1ea7n t\u1eadp l\u1edbn g\u1ed3m 5.415 b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh, kh\u00f4ng c\u00f3 b\u1ec7nh n\u1eb7ng \u0111i k\u00e8m c\u00f3 lo\u00e9t ch\u1ea3y m\u00e1u \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn qua n\u1ed9i soi. K\u1ebft qu\u1ea3 cho th\u1ea5y n\u1ed9i soi trong v\u00f2ng 24 gi\u1edd k\u1ec3 t\u1eeb khi nh\u1eadp vi\u1ec7n c\u00f3 xu h\u01b0\u1edbng gi\u1ea3m t\u1eed vong trong th\u1eddi gian n\u1eb1m vi\u1ec7n nh\u01b0ng kh\u00f4ng l\u00e0m gi\u1ea3m t\u1eed vong sau 30 ng\u00e0y.<\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng nguy c\u01a1 cao. C\u00e1c h\u01b0\u1edbng d\u1eabn tr\u01b0\u1edbc \u0111\u00e2y \u0111\u00e3 g\u1ee3i \u00fd c\u00e2n nh\u1eafc n\u1ed9i soi trong v\u00f2ng 12 gi\u1edd \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m nguy c\u01a1 cao nh\u01b0 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c x\u01a1 gan, m\u1eb7c d\u00f9 b\u1eb1ng ch\u1ee9ng h\u1ed7 tr\u1ee3 l\u00e0 r\u1ea5t h\u1ea1n ch\u1ebf. C\u00e1c nghi\u00ean c\u1ee9u li\u00ean quan \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh bao g\u1ed3m 2 nghi\u00ean c\u1ee9u, nh\u01b0ng k\u1ebft qu\u1ea3 kh\u00f4ng nh\u1ea5t qu\u00e1n. M\u1ed9t nghi\u00ean c\u1ee9u thu\u1ea7n t\u1eadp \u0111\u1ea1i \u0110an M\u1ea1ch tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 lo\u00e9t ch\u1ea3y m\u00e1u \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn qua n\u1ed9i soi cho th\u1ea5y t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nguy c\u01a1 cao khi n\u1ed9i soi \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n qu\u00e1 s\u1edbm ho\u1eb7c qu\u00e1 mu\u1ed9n. C\u1ee5 th\u1ec3, t\u1ef7 l\u1ec7 t\u1eed vong trong vi\u1ec7n th\u1ea5p h\u01a1n khi n\u1ed9i soi \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n 6-24 gi\u1edd sau nh\u1eadp vi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u00e0 12-36 gi\u1edd sau nh\u1eadp vi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh nh\u01b0ng c\u00f3 b\u1ec7nh n\u1ec1n k\u00e8m theo so v\u1edbi khi n\u1ed9i soi \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ngo\u00e0i c\u00e1c kho\u1ea3ng th\u1eddi gian n\u00e0y. Nghi\u00ean c\u1ee9u n\u00e0y \u0111\u1eb7t ra kh\u1ea3 n\u0103ng n\u1ed9i soi qu\u00e1 s\u1edbm c\u00f3 th\u1ec3 g\u00e2y h\u1ea1i n\u1ebfu ch\u01b0a ti\u1ebfn h\u00e0nh h\u1ed3i s\u1ee9c huy\u1ebft \u0111\u1ed9ng \u0111\u1ea7y \u0111\u1ee7 v\u00e0 x\u1eed tr\u00ed c\u00e1c b\u1ec7nh n\u1ec1n \u0111ang di\u1ec5n ti\u1ebfn tr\u01b0\u1edbc khi n\u1ed9i soi. Ng\u01b0\u1ee3c l\u1ea1i, m\u1ed9t nghi\u00ean \u0111\u01a1n trung t\u00e2m t\u1ea1i H\u00e0n Qu\u1ed1c cho th\u1ea5y t\u1ef7 l\u1ec7 t\u1eed vong sau 28 ng\u00e0y gi\u1ea3m khi n\u1ed9i soi \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong v\u00f2ng 6 gi\u1edd so v\u1edbi 6-48 gi\u1edd sau khi b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m.<\/p>\n
M\u1ed9t th\u1eed nghi\u1ec7m RCT ban \u0111\u1ea7u \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o d\u01b0\u1edbi d\u1ea1ng t\u00f3m t\u1eaft n\u0103m 2015 v\u1edbi k\u1ebft qu\u1ea3 t\u1ea1m th\u1eddi v\u00e0 sau \u0111\u00f3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 \u0111\u1ea7y \u0111\u1ee7 v\u00e0o n\u0103m 2020 \u0111\u00e3 so s\u00e1nh n\u1ed9i soi kh\u1ea9n trong v\u00f2ng 6 gi\u1edd sau khi h\u1ed9i ch\u1ea9n chuy\u00ean khoa ti\u00eau h\u00f3a v\u1edbi nh\u00f3m \u0111\u1ed1i ch\u1ee9ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh n\u1ed9i soi trong v\u00f2ng 6-24 gi\u1edd sau h\u1ed9i ch\u1ea9n \u1edf 516 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u1ef1 \u0111o\u00e1n nguy c\u01a1 cao d\u1ef1a tr\u00ean \u0111i\u1ec3m GBS \u2265 12. K\u1ebft qu\u1ea3 cho th\u1ea5y kh\u00f4ng gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t c\u0169ng nh\u01b0 kh\u00f4ng gi\u1ea3m t\u1eed vong khi n\u1ed9i soi s\u1edbm. T\u01b0\u01a1ng t\u1ef1, kh\u00f4ng ghi nh\u1eadn l\u1ee3i \u00edch v\u1ec1 th\u1eddi gian n\u1eb1m vi\u1ec7n hay nhu c\u1ea7u truy\u1ec1n m\u00e1u, m\u1eb7c d\u00f9 can thi\u1ec7p c\u1ea7m m\u00e1u n\u1ed9i soi \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nhi\u1ec1u h\u01a1n 11.6% \u1edf nh\u00f3m n\u1ed9i soi kh\u1ea9n. Do c\u00f3 kho\u1ea3ng c\u00e1ch th\u1eddi gian t\u1eeb l\u00fac b\u1ec7nh nh\u00e2n \u0111\u1ebfn vi\u1ec7n \u0111\u1ebfn khi \u0111\u01b0\u1ee3c ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean, nghi\u00ean c\u1ee9u th\u1ef1c t\u1ebf \u0111\u00e3 so s\u00e1nh n\u1ed9i soi t\u1ea1i th\u1eddi \u0111i\u1ec3m trung b\u00ecnh 10 gi\u1edd so v\u1edbi 25 gi\u1edd sau khi \u0111\u1ebfn vi\u1ec7n, v\u1edbi 55% b\u1ec7nh nh\u00e2n nh\u00f3m \u0111\u1ed1i ch\u1ee9ng \u0111\u01b0\u1ee3c n\u1ed9i soi sau h\u01a1n 24 gi\u1edd. Nh\u1eefng d\u1eef li\u1ec7u n\u00e0y g\u1ee3i \u00fd r\u1eb1ng kho\u1ea3ng th\u1eddi gian ch\u1edd n\u1ed9i soi th\u1eadm ch\u00ed tr\u00ean 24 gi\u1edd c\u00f3 th\u1ec3 v\u1eabn ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p.<\/p>\n
Nghi\u00ean c\u1ee9u n\u00e0y lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh nh\u00e2n s\u1ed1c t\u1ee5t huy\u1ebft \u00e1p kh\u00f4ng \u1ed5n \u0111\u1ecbnh sau h\u1ed3i s\u1ee9c ban \u0111\u1ea7u, nh\u00f3m ch\u1ec9 chi\u1ebfm kho\u1ea3ng 5% b\u1ec7nh nh\u00e2n nguy c\u01a1 cao. D\u1ef1a tr\u00ean kinh nghi\u1ec7m l\u00e2m s\u00e0ng, h\u1ed9i \u0111\u1ed3ng chuy\u00ean gia cho r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y c\u1ea7n can thi\u1ec7p kh\u1ea9n, b\u1eb1ng n\u1ed9i soi ho\u1eb7c can thi\u1ec7p m\u1ea1ch.<\/p>\n
K\u1ebft lu\u1eadn<\/h4>\n
H\u1ed9i \u0111\u1ed3ng khuy\u1ebfn ngh\u1ecb r\u1eb1ng c\u00e1c b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n ho\u1eb7c \u0111ang \u0111\u01b0\u1ee3c theo d\u00f5i t\u1ea1i b\u1ec7nh vi\u1ec7n v\u00ec xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean r\u00f5 r\u00e0ng, d\u00f9 \u0111\u01b0\u1ee3c d\u1ef1 \u0111o\u00e1n nguy c\u01a1 th\u1ea5p hay cao v\u1ec1 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t v\u00e0 t\u1eed vong, n\u00ean \u0111\u01b0\u1ee3c n\u1ed9i soi ti\u00eau h\u00f3a trong v\u00f2ng 24 gi\u1edd k\u1ec3 t\u1eeb khi \u0111\u1ebfn kh\u00e1m. Quy\u1ebft \u0111\u1ecbnh n\u00e0y d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng v\u1ec1 l\u1ee3i \u00edch kinh t\u1ebf (gi\u1ea3m th\u1eddi gian n\u1eb1m vi\u1ec7n) c\u0169ng nh\u01b0 l\u1ee3i \u00edch l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 c\u00f3 v\u1ec1 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 nhu c\u1ea7u ph\u1eabu thu\u1eadt trong c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t. Ch\u00fang t\u00f4i l\u1ef1a ch\u1ecdn t\u00ednh th\u1eddi gian t\u1eeb l\u00fac b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m thay v\u00ec t\u1eeb l\u00fac nh\u1eadp vi\u1ec7n, do s\u1ef1 kh\u00e1c bi\u1ec7t l\u1edbn v\u1ec1 th\u1eddi gian t\u1eeb khi \u0111\u1ebfn kh\u00e1m \u0111\u1ebfn khi nh\u1eadp vi\u1ec7n gi\u1eefa c\u00e1c c\u01a1 s\u1edf y t\u1ebf. M\u1eb7c d\u00f9 c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t \u1ee7ng h\u1ed9 m\u1ed1c \u201ctrong v\u00f2ng 1 ng\u00e0y\u201d s\u1eed d\u1ee5ng th\u1eddi \u0111i\u1ec3m nh\u1eadp vi\u1ec7n, h\u1ed9i \u0111\u1ed3ng lo ng\u1ea1i r\u1eb1ng \u1edf nh\u1eefng n\u01a1i k\u00e9o d\u00e0i gi\u1eefa th\u1eddi gian kh\u00e1m v\u00e0 nh\u1eadp vi\u1ec7n, vi\u1ec7c t\u00ednh t\u1eeb l\u00fac nh\u1eadp vi\u1ec7n c\u00f3 th\u1ec3 g\u00e2y tr\u00ec ho\u00e3n n\u1ed9i soi qu\u00e1 m\u1ee9c ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c. Trong c\u00e1c d\u1eef li\u1ec7u t\u1eeb m\u1ed9t nghi\u00ean c\u1ee9u quan s\u00e1t l\u1edbn cho th\u1ea5y kh\u1ea3 n\u0103ng g\u00e2y h\u1ea1i khi n\u1ed9i soi qu\u00e1 s\u1edbm \u1edf b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c c\u00f3 b\u1ec7nh n\u1ec1n \u0111\u00e1ng k\u1ec3, c\u00f9ng v\u1edbi m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean l\u1edbn cho th\u1ea5y kh\u00f4ng c\u00f3 l\u1ee3i \u00edch c\u1ee7a n\u1ed9i soi r\u1ea5t s\u1edbm \u1edf b\u1ec7nh nh\u00e2n nguy c\u01a1 cao, h\u1ed9i \u0111\u1ed3ng th\u1ed1ng nh\u1ea5t r\u1eb1ng c\u1ea7n h\u1ed3i s\u1ee9c \u0111\u1ea7y \u0111\u1ee7 v\u00e0 x\u1eed tr\u00ed c\u00e1c b\u1ec7nh n\u1ec1n \u0111ang di\u1ec5n ti\u1ebfn tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh n\u1ed9i soi. Do \u0111\u00f3, h\u1ed9i \u0111\u1ed3ng kh\u00f4ng \u0111\u01b0a v\u00e0o khuy\u1ebfn ngh\u1ecb t\u1eeb h\u01b0\u1edbng d\u1eabn n\u0103m 2012 r\u1eb1ng n\u1ed9i soi trong v\u00f2ng 12 gi\u1edd \u201cc\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc\u201d \u1edf b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m nguy c\u01a1 cao. H\u1ed9i \u0111\u1ed3ng c\u0169ng l\u01b0u \u00fd r\u1eb1ng c\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y c\u00f3 v\u1ebb kh\u00e1c v\u1edbi x\u1eed tr\u00ed s\u1ed1c m\u1ea5t m\u00e1u do ch\u1ea5n th\u01b0\u01a1ng, v\u1ed1n c\u00f3 th\u1ec3 bao g\u1ed3m can thi\u1ec7p c\u1ea7m m\u00e1u nhanh, h\u1ea1n ch\u1ebf truy\u1ec1n d\u1ecbch tinh th\u1ec3 v\u00e0 m\u1ee5c ti\u00eau huy\u1ebft \u00e1p th\u1ea5p. Tuy nhi\u00ean, ch\u01b0a r\u00f5 li\u1ec7u c\u00e1c chi\u1ebfn l\u01b0\u1ee3c n\u00e0y c\u00f3 mang l\u1ea1i l\u1ee3i \u00edch cho m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n s\u1ed1c do xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean hay kh\u00f4ng. D\u1eef li\u1ec7u \u1edf b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh, kh\u00f4ng c\u00f3 b\u1ec7nh n\u1ec1n k\u00e8m theo cho th\u1ea5y n\u00ean th\u1ef1c hi\u1ec7n n\u1ed9i soi c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t trong gi\u1edd l\u00e0m vi\u1ec7c th\u00f4ng th\u01b0\u1eddng, v\u00ec c\u00f3 th\u1ec3 cho ph\u00e9p xu\u1ea5t vi\u1ec7n s\u1edbm \u1edf m\u1ed9t t\u1ef7 l\u1ec7 \u0111\u00e1ng k\u1ec3 b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng nguy c\u01a1 th\u1ea5p tr\u00ean n\u1ed9i soi, t\u1eeb \u0111\u00f3 gi\u1ea3m th\u1eddi gian n\u1eb1m vi\u1ec7n v\u00e0 chi ph\u00ed.<\/p>\n
$\"X\u1eed$
X\u1eed tr\u00ed ban \u0111\u1ea7u \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m v\u1edbi xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean r\u00f5 r\u00e0ng. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c c\u00f4ng c\u1ee5 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 trong t\u01b0\u01a1ng lai n\u1ebfu thang \u0111i\u1ec3m \u0111\u00f3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c nguy c\u01a1 c\u1ea7n truy\u1ec1n m\u00e1u, can thi\u1ec7p c\u1ea7m m\u00e1u ho\u1eb7c t\u1eed vong v\u1edbi \u0111\u1ed9 nh\u1ea1y 99-100% (t\u1ef7 l\u1ec7 \u00e2m t\u00ednh gi\u1ea3 0%-1%).<\/figcaption><\/figure>\n
Ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi \u1edf b\u1ec7nh nh\u00e2n UGIB do lo\u00e9t c\u00f3 ch\u1ea3y m\u00e1u th\u00e0nh tia, ch\u1ea3y m\u00e1u r\u1ec9 r\u1ea3, ho\u1eb7c c\u00f3 m\u1ea1ch m\u00e1u l\u1ed9 kh\u00f4ng ch\u1ea3y m\u00e1u (khuy\u1ebfn c\u00e1o m\u1ea1nh, ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng trung b\u00ecnh<\/strong><\/p>\n
T\u00f3m t\u1eaft b\u1eb1ng ch\u1ee9ng<\/h4>\n
M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p n\u0103m 2009 g\u1ed3m 19 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng cho th\u1ea5y l\u1ee3i \u00edch r\u00f5 r\u1ec7t c\u1ee7a \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi so v\u1edbi \u0111i\u1ec1u tr\u1ecb kh\u00f4ng n\u1ed9i soi trong vi\u1ec7c gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t \u1edf b\u1ec7nh nh\u00e2n \u0111ang b\u1ecb ch\u1ea3y m\u00e1u v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 l\u1ed9 m\u1ea1ch m\u00e1u kh\u00f4ng ch\u1ea3y m\u00e1u. Tuy nhi\u00ean, ch\u01b0a ghi nh\u1eadn l\u1ee3i \u00edch v\u1ec1 gi\u1ea3m t\u1eed vong. Kh\u00f4ng c\u00f3 th\u00eam th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean ph\u00f9 h\u1ee3p n\u00e0o \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 sau \u0111\u00f3.<\/p>\n
H\u1ea7u h\u1ebft c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u00e0 ph\u00e2n t\u00edch g\u1ed9p \u0111\u01b0\u1ee3c tr\u00edch d\u1eabn \u0111\u1ec1u g\u1ed9p ch\u1ea3y m\u00e1u phun th\u00e0nh tia v\u00e0 r\u1ec9 m\u00e1u v\u00e0o m\u1ed9t nh\u00f3m chung g\u1ecdi l\u00e0 \u201cch\u1ea3y m\u00e1u ho\u1ea1t \u0111\u1ed9ng\u201d. Trong th\u1ef1c t\u1ebf, ch\u1ea3y m\u00e1u phun th\u00e0nh tia \u00edt g\u1eb7p h\u01a1n nhi\u1ec1u so v\u1edbi r\u1ec9 m\u00e1u. Ngo\u00e0i ra, nguy c\u01a1 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t c\u00f3 v\u1ebb cao h\u01a1n \u1edf b\u1ec7nh nh\u00e2n ch\u1ea3y m\u00e1u phun th\u00e0nh tia so v\u1edbi r\u1ec9 m\u00e1u. Tuy nhi\u00ean, ngay c\u1ea3 \u1edf b\u1ec7nh nh\u00e2n r\u1ec9 m\u00e1u m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi, t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t v\u1eabn \u0111\u1ee7 cao \u0111\u1ec3 \u1ee7ng h\u1ed9 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi. M\u1ed9t t\u1ed5ng h\u1ee3p t\u1eeb 8 th\u1eed nghi\u1ec7m ti\u1ebfn c\u1ee9u tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n r\u1ec9 m\u00e1u kh\u00f4ng \u0111\u01b0\u1ee3c can thi\u1ec7p n\u1ed9i soi cho th\u1ea5y t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t g\u1ed9p l\u00e0 39%. C\u1ea7n l\u01b0u \u00fd \u0111\u1ecbnh ngh\u0129a \u201cr\u1ec9 m\u00e1u\u201d c\u00f3 th\u1ec3 kh\u00e1c nhau \u0111\u00e1ng k\u1ec3 gi\u1eefa c\u00e1c b\u00e1c s\u0129 n\u1ed9i soi. M\u1ed9t s\u1ed1 th\u1eed nghi\u1ec7m y\u00eau c\u1ea7u ch\u1ea3y m\u00e1u li\u00ean t\u1ee5c trong 5 ph\u00fat quan s\u00e1t m\u1edbi \u0111\u01b0\u1ee3c xem l\u00e0 r\u1ec9 m\u00e1u ho\u1ea1t \u0111\u1ed9ng, nh\u1eb1m tr\u00e1nh ph\u00e2n lo\u1ea1i nh\u1ea7m c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ea3y m\u00e1u nh\u1eb9, tho\u00e1ng qua l\u00e0 r\u1ec9 m\u00e1u ho\u1ea1t \u0111\u1ed9ng.<\/p>\n
K\u1ebft lu\u1eadn<\/h4>\n
Nh\u01b0 \u0111\u00e3 n\u00eau trong h\u01b0\u1edbng d\u1eabn ACG n\u0103m 2012, \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi mang l\u1ea1i l\u1ee3i \u00edch l\u00e2m s\u00e0ng quan tr\u1ecdng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean do lo\u00e9t c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u nguy c\u01a1 cao, bao g\u1ed3m ch\u1ea3y m\u00e1u \u0111ang ho\u1ea1t \u0111\u1ed9ng v\u00e0 l\u1ed9 m\u1ea1ch m\u00e1u kh\u00f4ng ch\u1ea3y m\u00e1u.
\n(M\u1ee5c 7-12 li\u00ean quan \u0111\u1ebfn n\u1ed9i soi)<\/p>\n
Ch\u00fang t\u00f4i khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng PPI li\u1ec1u cao, truy\u1ec1n li\u00ean t\u1ee5c ho\u1eb7c ng\u1eaft qu\u00e3ng trong 3 ng\u00e0y sau khi \u0111\u00e3 c\u1ea7m m\u00e1u n\u1ed9i soi th\u00e0nh c\u00f4ng cho lo\u00e9t ch\u1ea3y m\u00e1u (khuy\u1ebfn c\u00e1o m\u1ea1nh, ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng t\u1eeb trung b\u00ecnh \u0111\u1ebfn cao)<\/strong><\/p>\n
T\u00f3m t\u1eaft b\u1eb1ng ch\u1ee9ng<\/h4>\n
Gi\u1ea3 thuy\u1ebft d\u1eabn \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng PPI li\u1ec1u cao \u1edf b\u1ec7nh nh\u00e2n lo\u00e9t ch\u1ea3y m\u00e1u l\u00e0 gi\u1ea3m acid trong d\u1ea1 d\u00e0y gi\u00fap th\u00fac \u0111\u1ea9y h\u00ecnh th\u00e0nh v\u00e0 \u1ed5n \u0111\u1ecbnh c\u1ee5c m\u00e1u \u0111\u00f4ng. Tuy nhi\u00ean, v\u1eabn ch\u01b0a r\u00f5 m\u1ee9c pH d\u1ea1 d\u00e0y m\u1ee5c ti\u00eau n\u00ean \u0111\u1ea1t g\u1ea7n 7 hay ch\u1ec9 c\u1ea7n \u1ee9c ch\u1ebf s\u1ef1 ti\u00eau h\u1ee7y c\u1ee5c m\u00e1u \u0111\u00f4ng do pepsin \u1edf pH > 4-5 l\u00e0 \u0111\u00e3 \u0111\u1ee7.<\/p>\n
Ch\u00fang t\u00f4i x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c 7 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi 8 so s\u00e1nh ng\u1eabu nhi\u00ean gi\u1eefa PPI li\u1ec1u cao (\u0111\u1ecbnh ngh\u0129a l\u00e0 \u2265 80 mg\/ng\u00e0y trong \u00edt nh\u1ea5t 3 ng\u00e0y) v\u1edbi gi\u1ea3 d\u01b0\u1ee3c (6 RCT) ho\u1eb7c kh\u00f4ng \u0111i\u1ec1u tr\u1ecb (2 so s\u00e1nh trong 1 RCT) sau khi \u0111\u00e3 c\u1ea7m m\u00e1u n\u1ed9i soi th\u00e0nh c\u00f4ng. Trong \u0111\u00f3, 4 so s\u00e1nh s\u1eed d\u1ee5ng PPI \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c v\u1edbi bolus 80 mg, sau \u0111\u00f3 truy\u1ec1n 8 mg\/gi\u1edd trong 72 gi\u1edd ; 4 so s\u00e1nh s\u1eed d\u1ee5ng PPI ng\u1eaft qu\u00e3ng g\u1ed3m 40 mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y, 20 mg u\u1ed1ng m\u1ed7i 6 gi\u1edd, ho\u1eb7c bolus 80 mg, sau \u0111\u00f3 40 mg t\u0129nh m\u1ea1ch m\u1ed7i 12 gi\u1edd. C\u00f3 7 so s\u00e1nh t\u1eeb ch\u00e2u \u00c1 v\u00e0 1 t\u1eeb Iran. B\u1eb1ng ch\u1ee9ng ch\u1ea5t l\u01b0\u1ee3ng cao cho th\u1ea5y PPI l\u00e0m gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t, t\u1eed vong v\u00e0 nhu c\u1ea7u ph\u1eabu thu\u1eadt r\u00f5 r\u1ec7t so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c\/kh\u00f4ng \u0111i\u1ec1u tr\u1ecb. Ph\u00e2n t\u00edch theo ph\u00e2n nh\u00f3m kh\u00f4ng ghi nh\u1eadn s\u1ef1 kh\u00e1c bi\u1ec7t hi\u1ec7u qu\u1ea3 gi\u1eefa truy\u1ec1n PPI li\u00ean t\u1ee5c v\u00e0 PPI ng\u1eaft qu\u00e3ng.<\/p>\n
Ch\u00fang t\u00f4i x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c 9 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng so s\u00e1nh PPI li\u1ec1u cao v\u1edbi thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 H2 sau khi \u0111\u00e3 c\u1ea7m m\u00e1u n\u1ed9i soi th\u00e0nh c\u00f4ng. Trong \u0111\u00f3, 4 RCT s\u1eed d\u1ee5ng PPI t\u0129nh m\u1ea1ch v\u1edbi li\u1ec1u bolus 80 mg, sau \u0111\u00f3 truy\u1ec1n 8 mg\/gi\u1edd ; 1 RCT s\u1eed d\u1ee5ng li\u1ec1u bolus 40 mg, sau \u0111\u00f3 truy\u1ec1n 6,7 mg\/gi\u1edd ; 4 RCT s\u1eed d\u1ee5ng PPI t\u0129nh m\u1ea1ch ng\u1eaft qu\u00e3ng bao g\u1ed3m 40 mg m\u1ed7i 6 gi\u1edd ho\u1eb7c m\u1ed7i 12 gi\u1edd, ho\u1eb7c bolus 80 mg, sau \u0111\u00f3 40 mg m\u1ed7i 8 gi\u1edd ho\u1eb7c 2 l\u1ea7n\/ng\u00e0y. C\u00f3 6 RCT \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u1ea1i Hoa K\u1ef3 ho\u1eb7c ch\u00e2u \u00c2u. B\u1eb1ng ch\u1ee9ng ch\u1ea5t l\u01b0\u1ee3ng trung b\u00ecnh cho th\u1ea5y PPI gi\u00fap gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t so v\u1edbi thu\u1ed1c \u0111\u1ed1i v\u1eadn th\u1ee5 th\u1ec3 H2. Tuy nhi\u00ean, kh\u00f4ng ghi nh\u1eadn s\u1ef1 gi\u1ea3m c\u00f3 \u00fd ngh\u0129a v\u1ec1 t\u1eed vong ho\u1eb7c nhu c\u1ea7u ph\u1eabu thu\u1eadt khi d\u00f9ng PPI. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c ph\u00e2n t\u00edch tr\u01b0\u1edbc, kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y s\u1ef1 kh\u00e1c bi\u1ec7t hi\u1ec7u qu\u1ea3 gi\u1eefa PPI truy\u1ec1n li\u00ean t\u1ee5c v\u00e0 PPI ng\u1eaft qu\u00e3ng.<\/p>\n
Ch\u00fang t\u00f4i x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c 12 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng so s\u00e1nh ph\u00e1c \u0111\u1ed3 bolus 80 mg, sau \u0111\u00f3 truy\u1ec1n li\u00ean t\u1ee5c 8 mg\/gi\u1edd trong 3 ng\u00e0y v\u1edbi c\u00e1c ph\u00e1c \u0111\u1ed3 PPI c\u01b0\u1eddng \u0111\u1ed9 th\u1ea5p h\u01a1n sau khi \u0111\u00e3 c\u1ea7m m\u00e1u n\u1ed9i soi th\u00e0nh c\u00f4ng. C\u00e1c ph\u00e1c \u0111\u1ed3 so s\u00e1nh bao g\u1ed3m : 40 mg\/ng\u00e0y trong 4 RCT ; 40 mg x 2 l\u1ea7n\/ng\u00e0y trong 3 RCT ; 80 mg x 2 l\u1ea7n\/ng\u00e0y trong 1 RCT ; bolus 80 mg, sau \u0111\u00f3 40-80 mg m\u1ed7i 6-12 gi\u1edd trong 3 RCT ; bolus 40 mg, sau \u0111\u00f3 truy\u1ec1n 4 mg\/gi\u1edd trong 1 RCT. K\u1ebft qu\u1ea3 ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y \u0111\u1ed1i v\u1edbi ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t, ph\u00e1c \u0111\u1ed3 bolus + truy\u1ec1n li\u00ean t\u1ee5c so v\u1edbi ph\u00e1c \u0111\u1ed3 \u00edt t\u00edch c\u1ef1c h\u01a1n c\u00f3 xu h\u01b0\u1edbng l\u00e0m t\u0103ng nh\u1eb9 nguy c\u01a1 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t. Tuy nhi\u00ean, gi\u1edbi h\u1ea1n d\u01b0\u1edbi c\u1ee7a kho\u1ea3ng tin c\u1eady 95% v\u1eabn ph\u00f9 h\u1ee3p v\u1edbi kh\u1ea3 n\u0103ng gi\u1ea3m nguy c\u01a1 t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ebfn 14% ho\u1eb7c gi\u1ea3m nguy c\u01a1 tuy\u1ec7t \u0111\u1ed1i 2% v\u1edbi ph\u00e1c \u0111\u1ed3 bolus + truy\u1ec1n li\u00ean t\u1ee5c. Ph\u00e2n t\u00edch theo nh\u00f3m cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a li\u00ean quan \u0111\u1ebfn li\u1ec1u d\u00f9ng, t\u1ea7n su\u1ea5t ho\u1eb7c \u0111\u01b0\u1eddng d\u00f9ng c\u1ee7a PPI.<\/p>\n
H\u1ed9i \u0111\u1ed3ng \u0111\u00e3 \u0111\u01b0a ra khuy\u1ebfn c\u00e1o m\u1ea1nh v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng PPI li\u1ec1u cao, truy\u1ec1n li\u00ean t\u1ee5c ho\u1eb7c ng\u1eaft qu\u00e3ng trong 3 ng\u00e0y sau khi c\u1ea7m m\u00e1u n\u1ed9i soi th\u00e0nh c\u00f4ng, d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng ch\u1ea5t l\u01b0\u1ee3ng cao cho th\u1ea5y gi\u1ea3m \u0111\u00e1ng k\u1ec3 nguy c\u01a1 ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t v\u00e0 t\u1eed vong so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c\/kh\u00f4ng \u0111i\u1ec1u tr\u1ecb, v\u00e0 b\u1eb1ng ch\u1ee9ng ch\u1ea5t l\u01b0\u1ee3ng trung b\u00ecnh cho th\u1ea5y gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t so v\u1edbi thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 H2. M\u1ee9c \u0111\u1ed9 l\u1ee3i \u00edch trong c\u00e1c RCT n\u00e0y g\u1ea7n nh\u01b0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng gi\u1eefa ph\u00e1c \u0111\u1ed3 bolus li\u1ec1u cao, sau \u0111\u00f3 truy\u1ec1n li\u00ean t\u1ee5c (bolus 80 mg, truy\u1ec1n 8 mg\/gi\u1edd), v\u00e0 ph\u00e1c \u0111\u1ed3 PPI li\u1ec1u cao ng\u1eaft qu\u00e3ng v\u1edbi t\u1ed5ng li\u1ec1u trung b\u00ecnh 80-160 mg\/ng\u00e0y (m\u1ed9t s\u1ed1 c\u00f3 bolus kh\u1edfi \u0111\u1ea7u 80 mg).<\/p>\n
H\u1ed9i \u0111\u1ed3ng sau \u0111\u00f3 \u0111\u00e3 xem x\u00e9t li\u1ec1u d\u00f9ng v\u00e0 \u0111\u01b0\u1eddng d\u00f9ng c\u1ee7a c\u00e1c ph\u00e1c \u0111\u1ed3 PPI li\u1ec1u cao. B\u1eb1ng ch\u1ee9ng ch\u1ea5t l\u01b0\u1ee3ng cao \u1ee7ng h\u1ed9 ph\u00e1c \u0111\u1ed3 bolus 80 mg, sau \u0111\u00f3 truy\u1ec1n li\u00ean t\u1ee5c 8 mg\/gi\u1edd \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng PPI t\u0129nh m\u1ea1ch li\u1ec1u cao truy\u1ec1n li\u00ean t\u1ee5c. Ng\u01b0\u1ee3c l\u1ea1i, c\u00e1c d\u1eef li\u1ec7u hi\u1ec7n c\u00f3 ch\u01b0a cho ph\u00e9p x\u00e1c \u0111\u1ecbnh ch\u1eafc ch\u1eafn li\u1ec1u t\u1ed1i \u01b0u c\u1ee7a PPI li\u1ec1u cao d\u00f9ng ng\u1eaft qu\u00e3ng. D\u1ef1a tr\u00ean c\u00e1c RCT, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng li\u1ec1u ng\u1eaft qu\u00e3ng 40 mg, 2-4 l\u1ea7n\/ng\u00e0y, d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c t\u0129nh m\u1ea1ch. T\u1ed5ng li\u1ec1u cao h\u01a1n c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p h\u01a1n v\u1edbi c\u00e1c qu\u1ea7n th\u1ec3 ph\u01b0\u01a1ng T\u00e2y, do PPI \u0111\u01b0\u1ee3c ghi nh\u1eadn c\u00f3 t\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u1ef1c h\u1ecdc v\u00e0 l\u00e2m s\u00e0ng k\u00e9m h\u01a1n so v\u1edbi \u1edf c\u00e1c qu\u1ea7n th\u1ec3 ch\u00e2u \u00c1. M\u1ed9t li\u1ec1u bolus kh\u1edfi \u0111\u1ea7u 80 mg (\u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c t\u0129nh m\u1ea1ch) c\u00f3 th\u1ec3 th\u00edch h\u1ee3p nh\u1eb1m \u0111\u1ea1t hi\u1ec7u qu\u1ea3 t\u0103ng pH d\u1ea1 d\u00e0y nhanh h\u01a1n trong ng\u00e0y \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean. Li\u1ec1u ng\u1eaft qu\u00e3ng c\u00f3 th\u1ec3 d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng n\u1ebfu b\u1ec7nh nh\u00e2n t\u1ec9nh t\u00e1o, kh\u00f4ng bu\u1ed3n n\u00f4n, kh\u00f4ng n\u00f4n v\u00e0 kh\u00f4ng kh\u00f3 nu\u1ed1t. \u0110\u01b0\u1eddng u\u1ed1ng d\u01b0\u1eddng nh\u01b0 t\u1ea1o ra hi\u1ec7u qu\u1ea3 d\u01b0\u1ee3c l\u1ef1c h\u1ecdc t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi li\u1ec1u t\u0129nh m\u1ea1ch t\u01b0\u01a1ng \u0111\u01b0\u01a1ng, m\u1eb7c d\u00f9 s\u1ef1 t\u0103ng pH d\u1ea1 d\u00e0y ban \u0111\u1ea7u khi d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 th\u1ec3 ch\u1eadm h\u01a1n kho\u1ea3ng 15-60 ph\u00fat so v\u1edbi \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Vi\u1ec7c l\u1ef1a ch\u1ecdn gi\u1eefa truy\u1ec1n li\u00ean t\u1ee5c hay d\u00f9ng ng\u1eaft qu\u00e3ng c\u00f3 th\u1ec3 ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1c y\u1ebfu t\u1ed1 nh\u01b0 t\u00ednh thu\u1eadn ti\u1ec7n trong s\u1eed d\u1ee5ng v\u00e0 chi ph\u00ed.<\/p>\n
K\u1ebft lu\u1eadn<\/h4>\n
Li\u1ec7u ph\u00e1p PPI li\u1ec1u cao, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u2265 80 mg\/ng\u00e0y trong \u2265 3 ng\u00e0y, truy\u1ec1n li\u00ean t\u1ee5c ho\u1eb7c ng\u1eaft qu\u00e3ng sau khi c\u1ea7m m\u00e1u n\u1ed9i soi gi\u00fap gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t v\u00e0 t\u1eed vong. Ph\u00e1c \u0111\u1ed3 truy\u1ec1n li\u00ean t\u1ee5c n\u00ean l\u00e0 bolus 80 mg, sau \u0111\u00f3 truy\u1ec1n 8 mg\/gi\u1edd. Ng\u01b0\u1ee3c l\u1ea1i, li\u1ec1u t\u1ed1i \u01b0u c\u1ee7a PPI d\u00f9ng ng\u1eaft qu\u00e3ng (\u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c t\u0129nh m\u1ea1ch) v\u1eabn ch\u01b0a ch\u1eafc ch\u1eafn, tuy nhi\u00ean ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t bolus 80 mg, sau \u0111\u00f3 40 mg, 2-4 l\u1ea7n\/ng\u00e0y. Khuy\u1ebfn c\u00e1o hi\u1ec7n t\u1ea1i m\u1edf r\u1ed9ng so v\u1edbi h\u01b0\u1edbng d\u1eabn n\u0103m 2012 c\u1ee7a ACG, kh\u00f4ng ch\u1ec9 gi\u1edbi h\u1ea1n \u1edf PPI truy\u1ec1n li\u00ean t\u1ee5c m\u00e0 c\u00f2n bao g\u1ed3m PPI li\u1ec1u cao d\u00f9ng ng\u1eaft qu\u00e3ng \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c t\u0129nh m\u1ea1ch.<\/p>\n
$\"\u0110i\u1ec1u$
\u0110i\u1ec1u tr\u1ecb n\u1ed9i soi v\u00e0 n\u1ed9i khoa cho lo\u00e9t ch\u1ea3y m\u00e1u d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m n\u1ed9i soi c\u1ee7a \u1ed5 lo\u00e9t. \u0110\u1ed1i v\u1edbi ph\u00e1c \u0111\u1ed3 truy\u1ec1n li\u00ean t\u1ee5c, khuy\u1ebfn c\u00e1o bolus 80 mg, sau \u0111\u00f3 truy\u1ec1n 8 mg\/gi\u1edd trong 3 ng\u00e0y. \u0110\u1ed1i v\u1edbi ph\u00e1c \u0111\u1ed3 ng\u1eaft qu\u00e3ng, g\u1ee3i \u00fd d\u00f9ng 40 mg, 2-4 l\u1ea7n\/ng\u00e0y trong 3 ng\u00e0y, \u01b0u ti\u00ean \u0111\u01b0\u1eddng u\u1ed1ng n\u1ebfu kh\u1ea3 thi v\u00e0 c\u00f3 th\u1ec3 d\u00f9ng bolus kh\u1edfi \u0111\u1ea7u 80 mg. Li\u1ec7u ph\u00e1p PPI chu\u1ea9n (v\u00ed d\u1ee5 : PPI u\u1ed1ng 1 l\u1ea7n\/ng\u00e0y) \u0111\u00e3 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong c\u00e1c h\u01b0\u1edbng d\u1eabn tr\u01b0\u1edbc \u0111\u00e2y c\u1ee7a ACG, nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong t\u00e0i li\u1ec7u hi\u1ec7n t\u1ea1i.<\/figcaption><\/figure>\n
Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n nguy c\u01a1 cao b\u1ecb UGIB do lo\u00e9t, sau khi \u0111\u00e3 c\u1ea7m m\u00e1u n\u1ed9i soi v\u00e0 \u0111i\u1ec1u tr\u1ecb PPI li\u1ec1u cao ng\u1eafn h\u1ea1n t\u1ea1i b\u1ec7nh vi\u1ec7n, n\u00ean ti\u1ebfp t\u1ee5c d\u00f9ng PPI \u0111\u01b0\u1eddng u\u1ed1ng ng\u00e0y 2 l\u1ea7n cho \u0111\u1ebfn 2 tu\u1ea7n sau l\u1ea7n n\u1ed9i soi ban \u0111\u1ea7u (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng th\u1ea5p)<\/strong><\/p>\n
T\u00f3m t\u1eaft b\u1eb1ng ch\u1ee9ng<\/h4>\n
H\u1ed9i \u0111\u1ed3ng \u0111\u00e3 xem x\u00e9t li\u1ec1u PPI \u1edf c\u00e1c b\u1ec7nh nh\u00e2n nguy c\u01a1 cao \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi v\u00e0 d\u00f9ng PPI li\u1ec1u cao ng\u1eafn h\u1ea1n. Ch\u1ec9 c\u00f3 m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh, bao g\u1ed3m c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m Rockall \u2265 6, \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea7m m\u00e1u n\u1ed9i soi th\u00e0nh c\u00f4ng \u0111\u1ed1i v\u1edbi lo\u00e9t c\u00f3 ch\u1ea3y m\u00e1u ho\u1ea1t \u0111\u1ed9ng, l\u1ed9 m\u1ea1ch m\u00e1u kh\u00f4ng ch\u1ea3y m\u00e1u ho\u1eb7c c\u1ee5c m\u00e1u \u0111\u00f4ng b\u00e1m d\u00ednh, v\u00e0 \u0111\u00e3 d\u00f9ng PPI bolus r\u1ed3i truy\u1ec1n li\u00ean t\u1ee5c trong 3 ng\u00e0y. C\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean d\u00f9ng esomeprazole 40 mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y so v\u1edbi 1 l\u1ea7n\/ng\u00e0y trong 11 ng\u00e0y, sau \u0111\u00f3 t\u1ea5t c\u1ea3 \u0111\u1ec1u ti\u1ebfp t\u1ee5c esomeprazole 40 mg\/ng\u00e0y th\u00eam 2 tu\u1ea7n. K\u1ebft qu\u1ea3 cho th\u1ea5y gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t \u1edf c\u1ea3 m\u1ed1c 14 ng\u00e0y v\u00e0 ph\u00e2n t\u00edch ch\u00ednh t\u1ea1i 28 ng\u00e0y. Vi\u1ec7c d\u00f9ng PPI u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y trong kho\u1ea3ng 2 tu\u1ea7n \u0111\u01b0\u1ee3c h\u1ed9i \u0111\u1ed3ng \u0111\u00e1nh gi\u00e1 l\u00e0 an to\u00e0n, dung n\u1ea1p t\u1ed1t, d\u1ec5 ti\u1ebfp c\u1eadn v\u00e0 chi ph\u00ed t\u01b0\u01a1ng \u0111\u1ed1i th\u1ea5p. Nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0y, c\u00f9ng v\u1edbi b\u1eb1ng ch\u1ee9ng hi\u1ec7u qu\u1ea3 c\u00f2n h\u1ea1n ch\u1ebf nh\u01b0ng c\u00f3 l\u1ee3i trong gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t, \u0111\u00e3 d\u1eabn \u0111\u1ebfn khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n s\u1eed d\u1ee5ng PPI 2 l\u1ea7n\/ng\u00e0y \u0111\u1ebfn 2 tu\u1ea7n sau n\u1ed9i soi ban \u0111\u1ea7u \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y. Sau 2 tu\u1ea7n, theo ph\u00e1c \u0111\u1ed3 c\u1ee7a nghi\u00ean c\u1ee9u RCT tr\u00ean, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c chuy\u1ec3n sang PPI 1 l\u1ea7n\/ng\u00e0y trong 2 tu\u1ea7n ti\u1ebfp theo. Tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3 ch\u01b0a \u0111\u1ee7 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh li\u1ec7u vi\u1ec7c k\u00e9o d\u00e0i th\u1eddi gian d\u00f9ng PPI 2 l\u1ea7n\/ng\u00e0y ho\u1eb7c k\u00e9o d\u00e0i t\u1ed5ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb PPI c\u00f3 mang l\u1ea1i th\u00eam l\u1ee3i \u00edch hay kh\u00f4ng.<\/p>\n
K\u1ebft lu\u1eadn<\/h4>\n
\u1ede b\u1ec7nh nh\u00e2n nguy c\u01a1 cao \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed9i soi v\u00e0 d\u00f9ng PPI li\u1ec1u cao trong 3 ng\u00e0y, vi\u1ec7c d\u00f9ng PPI 2 l\u1ea7n\/ng\u00e0y t\u1eeb ng\u00e0y 4 \u0111\u1ebfn ng\u00e0y 14 sau n\u1ed9i soi gi\u00fap gi\u1ea3m ch\u1ea3y m\u00e1u t\u00e1i ph\u00e1t so v\u1edbi d\u00f9ng 1 l\u1ea7n\/ng\u00e0y. \u0110\u00e2y l\u00e0 khuy\u1ebfn c\u00e1o m\u1edbi d\u1ef1a tr\u00ean c\u00e1c b\u1eb1ng ch\u1ee9ng xu\u1ea5t hi\u1ec7n sau khi c\u00f4ng b\u1ed1 h\u01b0\u1edbng d\u1eabn n\u0103m 2012 c\u1ee7a ACG.<\/p>\n
T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n
Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917. doi: 10.14309\/ajg.0000000000001245.<\/p>\n","protected":false},"excerpt":{"rendered":"
B\u1ea3n d\u1ecbch: QU\u1ea2N L\u00dd XU\u1ea4T HUY\u1ebeT TI\u00caU H\u00d3A TR\u00caN THEO ACG 2021 – \u0110\u01b0\u1ee3c d\u1ecbch b\u1edfi NT HN \u0110\u1ec1 xu\u1ea5t \u0111\u00e1nh gi\u00e1 nguy c\u01a1 t\u1ea1i khoa c\u1ea5p c\u1ee9u \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n nguy c\u01a1 r\u1ea5t th\u1ea5p (v\u00ed d\u1ee5: \u0111i\u1ec3m Glasgow-Blatchford 0-1) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c cho xu\u1ea5t vi\u1ec7n v\u00e0 theo d\u00f5i ngo\u1ea1i tr\u00fa. \u0110\u1ed1i […]\n","protected":false},"author":878,"featured_media":157295,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-157293","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\/157293","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\/878"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=157293"}],"version-history":[{"count":3,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/157293\/revisions"}],"predecessor-version":[{"id":157301,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/157293\/revisions\/157301"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/157295"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=157293"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=157293"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=157293"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa tr\u01b0\u1edbc n\u1ed9i soi<\/h3>\nCh\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t truy\u1ec1n erythromycin tr\u01b0\u1edbc khi n\u1ed9i soi \u1edf b\u1ec7nh nh\u00e2n UGIB (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p)<\/strong><\/p>\n

\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa tr\u01b0\u1edbc n\u1ed9i soi<\/h3>\n
Ch\u00fang t\u00f4i \u0111\u1ec1 xu\u1ea5t truy\u1ec1n erythromycin tr\u01b0\u1edbc khi n\u1ed9i soi \u1edf b\u1ec7nh nh\u00e2n UGIB (ch\u1ea5t l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p)<\/strong><\/p>\n