{"id":32971,"date":"2022-06-25T13:21:01","date_gmt":"2022-06-25T06:21:01","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=32971"},"modified":"2022-07-03T08:21:33","modified_gmt":"2022-07-03T01:21:33","slug":"viem-tuy-cap","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/viem-tuy-cap\/","title":{"rendered":"Vi\u00eam T\u1ee5y C\u1ea5p – Kh\u00e1i ni\u1ec7m, \u0111\u00e1nh gi\u00e1, d\u1ef1 \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 n\u1eb7ng nh\u1eb9 v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u0110\u1ec3 t\u1ea3i file PDF b\u00e0i vi\u1ebft Vi\u00eam T\u1ee5y C\u1ea5p, m\u1eddi c\u00e1c b\u1ea1n click v\u00e0o \u0111\u01b0\u1eddng link t\u1ea1i \u0111\u00e2y<\/a><\/p>\n

B\u1ea3n D\u1ecbch C\u1ee7a B\u00e1c S\u0129 Tr\u1ea7n Minh Th\u00e0nh- Khoa HSTC-C\u0110<\/p>\n

\u0110\u1eb6T V\u1ea4N \u0110\u1ec0<\/h2>\n
Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 l\u00fd do ph\u1ed5 bi\u1ebfn nh\u1ea5t nh\u1eadp vi\u1ec7n v\u1ec1 b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng ti\u00eau h\u00f3a \u1edf Hoa K\u1ef3 v\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn b\u1ec7nh t\u1eadt, t\u1eed vong v\u00e0 chi ph\u00ed \u0111i\u1ec1u tr\u1ecb. T\u1ef7 l\u1ec7 m\u1eafc vi\u00eam t\u1ee5y c\u1ea5p \u0111ang t\u0103ng l\u00ean, v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong t\u1eeb 5% \u0111\u1ebfn 20% \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. C\u00f3 nhi\u1ec1u nguy\u00ean nh\u00e2n g\u00e2y ra vi\u00eam t\u1ee5y c\u1ea5p, nh\u01b0ng s\u1ecfi m\u1eadt v\u00e0 nghi\u1ec7n r\u01b0\u1ee3u chi\u1ebfm g\u1ea7n 70% (B\u1ea3ng 50.1).<\/p>\n
Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam t\u1ee5y li\u00ean quan \u0111\u1ebfn c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau c\u1ee7a t\u00ecnh tr\u1ea1ng t\u1ef1 ti\u00eau, ph\u00f9 n\u1ec1, ho\u1ea1i t\u1eed v\u00e0 xu\u1ea5t huy\u1ebft m\u00f4 t\u1ee5y. Vi\u00eam t\u1ee5y c\u1ea5p c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n c\u00f3 th\u1ec3 l\u00e0m t\u1ed5n th\u01b0\u01a1ng ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c c\u01a1 quan kh\u00e1c v\u00e0 ti\u1ebfn tri\u1ec3n th\u00e0nh suy c\u01a1 quan ti\u1ebfp di\u1ec5n. Di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng thay \u0111\u1ed5i t\u1eeb c\u00e1c \u0111\u1ee3t nh\u1eb9, t\u1ef1 gi\u1edbi h\u1ea1n \u0111\u1ebfn vi\u00eam t\u1ee5y n\u1eb7ng v\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng \u0111a c\u01a1 quan k\u00e8m theo, c\u00e1c bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed7 nh\u01b0 t\u1ee5 d\u1ecbch quanh t\u1ee5y nhi\u1ec5m khu\u1ea9n, ho\u1eb7c c\u00e1c bi\u1ebfn ch\u1ee9ng ngo\u00e0i t\u1ee5y nh\u01b0 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch. C\u00f3 \u0111\u1ebfn 20% b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p c\u00f3 di\u1ec5n ti\u1ebfn n\u1eb7ng th\u01b0\u1eddng c\u1ea7n \u0111\u01b0\u1ee3c nh\u1eadp h\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u. T\u1ef7 l\u1ec7 t\u1eed vong c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng v\u1edbi c\u00e1c bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng l\u00e0 10% \u0111\u1ebfn 20% v\u00e0 c\u00f3 th\u1ec3 t\u0103ng l\u00ean tr\u00ean 50% khi c\u00f3 suy c\u01a1 quan ti\u1ebfp di\u1ec5n.<\/p>\n
S\u1ef0 \u0110\u00c1NH GI\u00c1<\/h2>\n
C\u1ea7n nghi ng\u1edd ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u1ee5y c\u1ea5p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u1edfi ph\u00e1t c\u1ea5p t\u00ednh v\u1edbi c\u01a1n \u0111au v\u00f9ng th\u01b0\u1ee3ng v\u1ecb d\u1eef d\u1ed9i. Ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u1ee5y c\u1ea5p c\u1ea7n hai trong ba ti\u00eau chu\u1ea9n sau: (1) \u0111au th\u01b0\u1ee3ng v\u1ecb d\u1eef d\u1ed9i kh\u1edfi ph\u00e1t c\u1ea5p t\u00ednh, c\u00f3 th\u1ec3 lan ra sau l\u01b0ng, (2) t\u0103ng amylase ho\u1eb7c lipase huy\u1ebft thanh g\u1ea5p ba l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a m\u1ee9c b\u00ecnh th\u01b0\u1eddng v\u00e0 (3) \u0111\u1eb7c \u0111i\u1ec3m ph\u00e1t hi\u1ec7n vi\u00eam t\u1ee5y tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc. C\u00e1c ch\u1ec9 \u0111\u1ecbnh ch\u0103m s\u00f3c theo d\u00f5i ho\u1eb7c ch\u0103m s\u00f3c t\u00edch c\u1ef1c \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong B\u1ea3ng 50.2.<\/p>\n
Vi\u1ec7c \u0111\u00e1nh gi\u00e1 m\u1ed9t b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam t\u1ee5y c\u1ea5p n\u00ean b\u1eaft \u0111\u1ea7u b\u1eb1ng khai th\u00e1c ti\u1ec1n s\u1eed c\u1ea9n th\u1eadn, ch\u00fa \u00fd \u0111\u1ebfn tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t, s\u1eed d\u1ee5ng r\u01b0\u1ee3u, b\u1ec7nh s\u1ecfi m\u1eadt, vi\u00eam t\u1ee5y tr\u01b0\u1edbc \u0111\u00f3, xem x\u00e9t c\u00e1c lo\u1ea1i thu\u1ed1c \u0111ang d\u00f9ng v\u00e0 ti\u1ec1n s\u1eed gia \u0111\u00ecnh v\u1ec1 vi\u00eam t\u1ee5y. Tri\u1ec7u ch\u1ee9ng ch\u00ednh c\u1ee7a b\u1ec7nh s\u1eed l\u00e0 \u0111au b\u1ee5ng, th\u01b0\u1eddng \u1edf v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, c\u00f3 th\u1ec3 lan ra sau l\u01b0ng. Th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n c\u1ea5p t\u00ednh v\u00e0 c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n. Th\u0103m kh\u00e1m, s\u1edd th\u1ea5y b\u1ee5ng c\u0103ng v\u00e0 ch\u01b0\u1edbng n\u1eb7ng. \u00c2m ru\u1ed9t kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng c\u00f3 th\u1ec3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a t\u1eafc ru\u1ed9t. Trong tr\u01b0\u1eddng h\u1ee3p nghi\u00eam tr\u1ecdng, c\u00f3 th\u1ec3 c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u to\u00e0n th\u00e2n trong h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam to\u00e0n th\u00e2n (SIRS) v\u1edbi s\u1ed1t, nh\u1ecbp tim nhanh v\u00e0 th\u1edf nhanh. C\u00e1c ph\u00e1t hi\u1ec7n b\u1ed5 sung cho th\u1ea5y b\u1ec7nh n\u1eb7ng bao g\u1ed3m gi\u1ea3m th\u00f4ng kh\u00ed, gi\u1ea3m oxy m\u00e1u v\u00e0 t\u00ecnh tr\u1ea1ng thay \u0111\u1ed5i tri gi\u00e1c. D\u1ea5u hi\u1ec7u Cullen (b\u1ea7m m\u00e1u quanh r\u1ed1n) v\u00e0 d\u1ea5u hi\u1ec7u Gray Turner (b\u1ea7m m\u00e1u v\u00f9ng s\u01b0\u1eddn) l\u00e0 nh\u1eefng d\u1ea5u hi\u1ec7u hi\u1ebfm g\u1eb7p v\u00e0 ch\u1ec9 ra vi\u00eam t\u1ee5y xu\u1ea5t huy\u1ebft trong b\u1ed1i c\u1ea3nh ho\u1ea1i t\u1eed t\u1ee5y.<\/p>\n
Trong giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a qu\u00e1 tr\u00ecnh vi\u00eam t\u1ee5y, c\u00e1c enzym ti\u00eau h\u00f3a r\u00f2 r\u1ec9 ra kh\u1ecfi t\u1ebf b\u00e0o tuy\u1ebfn t\u1ee5y v\u00e0 \u0111i v\u00e0o h\u1ec7 tu\u1ea7n ho\u00e0n. N\u1ed3ng \u0111\u1ed9 lipase huy\u1ebft thanh t\u0103ng s\u1edbm h\u01a1n v\u00e0 duy tr\u00ec l\u00e2u h\u01a1n so v\u1edbi amylase huy\u1ebft thanh. N\u1ed3ng \u0111\u1ed9 lipase huy\u1ebft thanh t\u0103ng l\u00ean g\u1ea5p ba l\u1ea7n m\u1ee9c cao h\u01a1n b\u00ecnh th\u01b0\u1eddng l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u nh\u1ea1y c\u1ea3m h\u01a1n amylase huy\u1ebft thanh \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u1ee5y c\u1ea5p (82% \u0111\u1ebfn 100% so v\u1edbi 67% \u0111\u1ebfn 83%). C\u1ea7n l\u01b0u \u00fd r\u1eb1ng n\u1ed3ng \u0111\u1ed9 enzym c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng \u1edf 5% b\u1ec7nh nh\u00e2n t\u1ea1i th\u1eddi \u0111i\u1ec3m nh\u1eadp vi\u1ec7n.<\/p>\n
$\"B\u1ea3ng$
B\u1ea3ng 50.1<\/figcaption><\/figure>\n
Ch\u1ec9 \u0111\u1ecbnh l\u00e0m th\u00eam c\u1eadn l\u00e2m s\u00e0ng kh\u00e1c khi b\u1eaft \u0111\u1ea7u nghi ng\u1edd vi\u00eam t\u1ee5y c\u1ea5p \u0111\u1ec3 h\u1ed7 tr\u1ee3 ph\u00e2n t\u1ea7ng nguy c\u01a1 bao g\u1ed3m x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan, c\u00f4ng th\u1ee9c m\u00e1u to\u00e0n b\u1ed9 (CBC), BUN, canxi v\u00e0 creatinin. T\u0103ng men gan (\u0111\u1eb7c bi\u1ec7t l\u00e0 transaminase) c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo t\u0103ng bilirubin m\u00e1u g\u1ee3i \u00fd s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a s\u1ecfi \u1ed1ng m\u1eadt ho\u1eb7c ch\u00e8n \u00e9p \u1ed1ng m\u1eadt ch\u1ee7 do ph\u00f9 n\u1ec1.<\/p>\n
$\"B\u1ea3ng$
B\u1ea3ng 50.2<\/figcaption><\/figure>\n
H\u00ecnh \u1ea3nh h\u1ecdc c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft khi c\u00f3 nghi ng\u1edd trong ch\u1ea9n \u0111o\u00e1n ho\u1eb7c \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u1ec1 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh. \u0110i\u1ec1u quan tr\u1ecdng c\u1ea7n l\u01b0u \u00fd l\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111au b\u1ee5ng \u0111\u1eb7c tr\u01b0ng v\u00e0 t\u0103ng amylase \/ lipase huy\u1ebft thanh, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n vi\u00eam t\u1ee5y c\u1ea5p. Si\u00eau \u00e2m \u1ed5 b\u1ee5ng n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 xem c\u00f3 s\u1ecfi \u0111\u01b0\u1eddng m\u1eadt ho\u1eb7c s\u1ecfi \u1ed1ng m\u1eadt ch\u1ee7 hay kh\u00f4ng, \u0111\u1eb7c bi\u1ec7t trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd vi\u00eam t\u1ee5y c\u1ea5p do s\u1ecfi m\u1eadt. Ph\u00e1t hi\u1ec7n s\u1edbm s\u1ecfi m\u1eadt gi\u00fap ch\u1ec9 \u0111\u1ecbnh x\u1eed tr\u00ed th\u00eam b\u1eb1ng c\u00e1ch n\u1ed9i soi m\u1eadt t\u1ee5y ng\u01b0\u1ee3c d\u00f2ng (ERCP) ho\u1eb7c c\u1eaft t\u00fai m\u1eadt.<\/p>\n
H\u00ecnh \u1ea3nh c\u1eaft ngang kh\u00f4ng b\u1eaft bu\u1ed9c trong \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u nh\u01b0ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n n\u1ebfu c\u00f3 lo ng\u1ea1i v\u1ec1 c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh c\u1ea3n quang (CECT) l\u00e0 ph\u01b0\u01a1ng ph\u00e1p t\u1ed1t nh\u1ea5t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng vi\u00eam t\u1ee5y, ho\u1ea1i t\u1eed v\u00e0 t\u1ee5 d\u1ecbch quanh t\u1ee5y. Nh\u1eefng ph\u00e1t hi\u1ec7n ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean h\u00ecnh \u1ea3nh trong vi\u00eam t\u1ee5y m\u00f4 k\u1ebd kh\u00f4ng bi\u1ebfn ch\u1ee9ng l\u00e0 ph\u00ec \u0111\u1ea1i to\u00e0n b\u1ed9 ho\u1eb7c m\u1ed9t ph\u1ea7n tuy\u1ebfn t\u1ee5y v\u1edbi s\u1ef1 m\u1edd c\u00e1c r\u00eca v\u00e0 nh\u1eefng thay \u0111\u1ed5i v\u1ec1 vi\u00eam. CECT \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf l\u1ea7n th\u0103m kh\u00e1m ban \u0111\u1ea7u c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 th\u1ea5p m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh v\u00ec n\u00f3 c\u00f3 th\u1ec3 c\u1ea7n \u0111\u1ebfn \u0111\u1ebfn 72 gi\u1edd \u0111\u1ec3 t\u00ecnh tr\u1ea1ng ho\u1ea1i t\u1eed ph\u00e1t tri\u1ec3n. Do \u0111\u00f3, n\u00ean tr\u00ec ho\u00e3n CECT tr\u1eeb khi c\u00f3 lo ng\u1ea1i v\u1ec1 c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c ho\u1eb7c n\u1ebfu nghi ng\u1edd ch\u1ea9n \u0111o\u00e1n.<\/p>\n
\u0110\u1ed1i v\u1edbi vi\u00eam t\u1ee5y c\u1ea5p t\u00e1i ph\u00e1t (hai ho\u1eb7c nhi\u1ec1u \u0111\u1ee3t), c\u1ea7n ti\u1ebfn h\u00e0nh ki\u1ec3m tra chi ti\u1ebft, bao g\u1ed3m c\u1ea3 m\u1ee9c immunoglobulin G4 (IgG4) \u0111\u1ec3 ki\u1ec3m tra vi\u00eam t\u1ee5y t\u1ef1 mi\u1ec5n, triglycerid v\u00e0 n\u1ed3ng \u0111\u1ed9 canxi huy\u1ebft thanh. C\u00e1c lo\u1ea1i thu\u1ed1c c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t k\u1ef9 l\u01b0\u1ee1ng v\u00ec nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh chi\u1ebfm 2% tr\u01b0\u1eddng h\u1ee3p vi\u00eam t\u1ee5y. Si\u00eau \u00e2m n\u1ed9i soi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ung th\u01b0 tuy\u1ebfn t\u1ee5y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c c\u0103n nguy\u00ean. Nghi\u00ean c\u1ee9u th\u00eam c\u0169ng c\u00f3 th\u1ec3 bao g\u1ed3m nghi\u00ean c\u1ee9u di truy\u1ec1n, \u0111\u00e1nh gi\u00e1 tuy\u1ebfn t\u1ee5y. C\u1eaft b\u1ecf t\u00fai m\u1eadt theo kinh nghi\u1ec7m n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam t\u1ee5y c\u1ea5p t\u00e1i ph\u00e1t, ngay c\u1ea3 khi ch\u1ee9c n\u0103ng gan b\u00ecnh th\u01b0\u1eddng v\u00e0 h\u00ecnh \u1ea3nh t\u00fai m\u1eadt b\u00ecnh th\u01b0\u1eddng. Kh\u00f4ng t\u00ecm th\u1ea5y c\u0103n nguy\u00ean r\u00f5 r\u00e0ng c\u1ee7a vi\u00eam t\u1ee5y \u1edf 10% \u0111\u1ebfn 20% b\u1ec7nh nh\u00e2n (vi\u00eam t\u1ee5y v\u00f4 c\u0103n).<\/p>\n
D\u1ef0 \u0110O\u00c1N M\u1ee8C \u0110\u1ed8 N\u1eb6NG<\/h2>\n
D\u1ef1 \u0111o\u00e1n s\u1edbm m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 quan tr\u1ecdng trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao t\u00e0n ph\u1ebf v\u00e0 t\u1eed vong. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c, v\u00ec kh\u00f4ng c\u00f3 c\u00e1ch duy nh\u1ea5t, \u0111\u00e1ng tin c\u1eady \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 n\u1eb7ng. C\u00e1c ch\u1ec9 s\u1ed1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng hi\u1ec7n t\u1ea1i d\u1ef1a tr\u00ean l\u00e2m s\u00e0ng v\u00e0 c\u00e1c th\u00f4ng s\u1ed1 h\u00ecnh \u1ea3nh h\u1ecdc. M\u1ed9t y\u1ebfu t\u1ed1 l\u00e2m s\u00e0ng quan tr\u1ecdng trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh l\u00e0 suy c\u01a1 quan k\u00e9o d\u00e0i h\u01a1n 48 gi\u1edd.<\/p>\n
Nhi\u1ec1u h\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i v\u00e0 cho \u0111i\u1ec3m kh\u00e1c nhau \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n \u0111\u1ec3 ph\u00e2n t\u1ea7ng nguy c\u01a1 b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y c\u1ea5p. Trong l\u1ecbch s\u1eed, ti\u00eau ch\u00ed Ranson v\u00e0 h\u1ec7 th\u1ed1ng t\u00ednh \u0111i\u1ec3m Glasgow \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, nh\u01b0ng ch\u00fang r\u1ea5t c\u1ed3ng k\u1ec1nh v\u00e0 c\u00f3 th\u1ec3 m\u1ea5t \u0111\u1ebfn 48 gi\u1edd \u0111\u1ec3 ho\u00e0n th\u00e0nh. G\u1ea7n \u0111\u00e2y h\u01a1n, APACHE II (Acute Physiology and Chronic Health Examination II) \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p, nh\u01b0ng n\u00f3 kh\u00f4ng d\u00e0nh ri\u00eang cho vi\u00eam t\u1ee5y. B\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec3m APACHE II> 8 th\u01b0\u1eddng b\u1ec7nh n\u1eb7ng. M\u1ed9t h\u1ec7 th\u1ed1ng t\u00ednh \u0111i\u1ec3m ti\u00ean l\u01b0\u1ee3ng m\u1edbi, ch\u1ec9 s\u1ed1 gi\u01b0\u1eddng b\u1ec7nh v\u1ec1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng trong vi\u00eam t\u1ee5y c\u1ea5p (BISAP), \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t nh\u01b0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01a1n gi\u1ea3n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh s\u1edbm b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 t\u1eed vong khi nh\u1eadp vi\u1ec7n v\u00e0 ch\u00ednh x\u00e1c nh\u01b0 c\u00e1c h\u1ec7 th\u1ed1ng t\u00ednh \u0111i\u1ec3m kh\u00e1c (B\u1ea3ng 50.3). M\u1ed9t \u0111i\u1ec3m \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho m\u1ed7i d\u1ea5u hi\u1ec7u sau \u0111\u00e2y trong v\u00f2ng 24 gi\u1edd sau khi xu\u1ea5t hi\u1ec7n: m\u1ee9c BUN> 25 mg \/ dL, thay \u0111\u1ed5i t\u00ecnh tr\u1ea1ng tri gi\u00e1c, hi\u1ec7n di\u1ec7n SIRS, tu\u1ed5i> 60 v\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc. \u0110i\u1ec3m BISAP \u2265 3 c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 bi\u1ebfn ch\u1ee9ng.<\/p>\n
C\u00e1c y\u1ebfu t\u1ed1 \u0111\u01a1n \u0111\u1ed9c kh\u00e1c khi nh\u1eadp vi\u1ec7n c\u00f3 li\u00ean quan \u0111\u1ebfn di\u1ec5n ti\u1ebfn n\u1eb7ng bao g\u1ed3m c\u00f4 \u0111\u1eb7c m\u00e1u (hematocrit> 44%), b\u00e9o ph\u00ec, protein ph\u1ea3n \u1ee9ng C (CRP)> 150 mg \/ dL, albumin <2,5 mg \/ dL, canxi ><8,5 mg \/ dL, BUN>20, v\u00e0 t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft s\u1edbm (B\u1ea3ng 50.4). C\u00e1c d\u1ea5u hi\u1ec7u k\u00edch ho\u1ea1t mi\u1ec5n d\u1ecbch kh\u00e1c nh\u01b0 interleukin (IL) -6, IL-8, IL-10, v\u00e0 y\u1ebfu t\u1ed1 ho\u1ea1i t\u1eed kh\u1ed1i u (TNF) c\u0169ng c\u00f3 li\u00ean quan \u0111\u1ebfn t\u00ecnh tr\u1ea1ng vi\u00eam t\u1ee5y c\u1ea5p, m\u1eb7c d\u00f9 kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m tra th\u01b0\u1eddng xuy\u00ean trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Nhi\u1ec1u nghi\u00ean c\u1ee9u kh\u00e1c \u0111\u00e3 ph\u00e1t hi\u1ec7n ra BUN l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 d\u1ef1 b\u00e1o t\u1ed1t v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong trong vi\u00eam t\u1ee5y c\u1ea5p. BUN> 20 c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 t\u1eed vong, c\u0169ng nh\u01b0 b\u1ea5t k\u1ef3 s\u1ef1 gia t\u0103ng BUN n\u00e0o sau 24 gi\u1edd sau khi nh\u1eadp vi\u1ec7n.<\/p>\n
$\"B\u1ea3ng$
B\u1ea3ng 50.3<\/figcaption><\/figure>\n
Ch\u1ec9 s\u1ed1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a CT (CTSI) l\u00e0 m\u1ed9t h\u1ec7 th\u1ed1ng t\u00ednh \u0111i\u1ec3m d\u1ef1a tr\u00ean h\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i CT t\u0103ng c\u01b0\u1eddng ch\u1ea5t c\u1ea3n quang (A-E) v\u00e0 t\u1ef7 l\u1ec7 ph\u1ea7n tr\u0103m ho\u1ea1i t\u1eed t\u1ee5y (B\u1ea3ng 50.5). Ho\u1ea1i t\u1eed t\u1ee5y xu\u1ea5t hi\u1ec7n nh\u01b0 m\u1ed9t v\u00f9ng ph\u00e2n chia r\u00f5 r\u00e0ng kh\u00f4ng t\u0103ng s\u00e1ng sau khi ti\u00eam thu\u1ed1c c\u1ea3n quang t\u0129nh m\u1ea1ch. \u0110i\u1ec3m> 6 cho th\u1ea5y b\u1ec7nh n\u1eb7ng v\u00e0 ti\u00ean l\u01b0\u1ee3ng k\u00e9m. C\u00f3 m\u1ed9t lo\u1ea1t c\u00e1c bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed7 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n tr\u00ean h\u00ecnh \u1ea3nh c\u1eaft ngang trong vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng. C\u00e1c d\u1ea5u hi\u1ec7u ban \u0111\u1ea7u bao g\u1ed3m ho\u1ea1i t\u1eed tuy\u1ebfn t\u1ee5y v\u00e0 t\u1ee5 d\u1ecbch c\u1ea5p t\u00ednh, h\u1ea7u nh\u01b0 lu\u00f4n v\u00f4 tr\u00f9ng. C\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf c\u00e1c giai \u0111o\u1ea1n kh\u00e1c nhau bao g\u1ed3m gi\u1ea3 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch quanh t\u1ee5y (v\u00ed d\u1ee5, \u0111\u1ed9ng m\u1ea1ch d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng, gan v\u00e0 l\u00e1ch) v\u00e0 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch (v\u00ed d\u1ee5, t\u0129nh m\u1ea1ch c\u1eeda, m\u1ea1c treo tr\u00e0ng tr\u00ean v\u00e0 l\u00e1ch). Ho\u1ea1i t\u1eed t\u1ee5y c\u00f3 th\u1ec3 v\u00f4 tr\u00f9ng (H\u00ecnh 50.lA) ho\u1eb7c nhi\u1ec5m tr\u00f9ng (H\u00ecnh 50.1 B). Ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng mu\u1ed9n, th\u01b0\u1eddng x\u1ea3y ra h\u01a1n 2 tu\u1ea7n sau khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng; tuy nhi\u00ean, c\u00e1c tr\u01b0\u1eddng h\u1ee3p ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng s\u1edbm \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. S\u1ed1t dai d\u1eb3ng, t\u0103ng b\u1ea1ch c\u1ea7u v\u00e0 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh k\u1ebft h\u1ee3p v\u1edbi kh\u00ed trong v\u00f9ng ho\u1ea1i t\u1eed l\u00e0 nh\u1eefng d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng. Nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ho\u1ea1i t\u1eed t\u1ee5y ch\u1ee9a kh\u00ed, huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh c\u00f3 kh\u1ea3 n\u0103ng \u0111\u00e3 ph\u00e1t tri\u1ec3n m\u1ed9t l\u1ed7 r\u00f2 t\u1ee5y. Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng ch\u1ecdc h\u00fat kim v\u00e0o v\u00f9ng ho\u1ea1i t\u1eed, nh\u01b0ng quy\u1ebft \u0111\u1ecbnh ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb x\u00e2m l\u1ea5n d\u1ef1a tr\u00ean s\u1ef1 \u1ed5n \u0111\u1ecbnh t\u1ed5ng th\u1ec3 c\u1ee7a b\u1ec7nh nh\u00e2n. B\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh, ngay c\u1ea3 khi ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u1eed tr\u00ed b\u1ea3o t\u1ed3n m\u00e0 kh\u00f4ng c\u1ea7n d\u1eabn l\u01b0u.<\/p>\n
$\"B\u1ea3ng$
B\u1ea3ng 50.4<\/figcaption><\/figure>\n
Ph\u00e2n lo\u1ea1i Atlanta s\u1eeda \u0111\u1ed5i (2012) \u0111\u00e3 m\u00f4 t\u1ea3 ba m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p: nh\u1eb9, trung b\u00ecnh v\u00e0 n\u1eb7ng (B\u1ea3ng 50.6). Trong vi\u00eam t\u1ee5y nh\u1eb9, kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed7 \/ to\u00e0n th\u00e2n ho\u1eb7c suy c\u01a1 quan. Nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y th\u01b0\u1eddng h\u1ed3i ph\u1ee5c v\u1edbi s\u1ef1 ch\u0103m s\u00f3c h\u1ed7 tr\u1ee3 trong v\u00f2ng m\u1ed9t tu\u1ea7n m\u00e0 kh\u00f4ng c\u00f3 bi\u1ebfn ch\u1ee9ng. B\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam t\u1ee5y c\u1ea5p m\u1ee9c \u0111\u1ed9 trung b\u00ecnh c\u00f3 suy t\u1ea1ng tho\u00e1ng qua t\u1ef1 kh\u1ecfi trong v\u00f2ng 48 gi\u1edd ho\u1eb7c bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed7 nh\u01b0 t\u1ee5 d\u1ecbch t\u1ee5y m\u00e0 kh\u00f4ng suy t\u1ea1ng ti\u1ebfp di\u1ec5n. Vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi suy t\u1ea1ng ti\u1ebfp di\u1ec5n> 48 gi\u1edd. Suy t\u1ea1ng ti\u1ebfp di\u1ec5n \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n c\u00f3 li\u00ean quan \u0111\u1ebfn 33% nguy c\u01a1 t\u1eed vong.<\/p>\n
\u0110I\u1ec0U TR\u1eca<\/h2>\n
Ph\u1ea7n n\u00e0y s\u1ebd \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb trong vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng, bao g\u1ed3m b\u00f9 d\u1ecbch qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (IVF), ki\u1ec3m so\u00e1t \u0111au, h\u1ed7 tr\u1ee3 dinh d\u01b0\u1ee1ng, vai tr\u00f2 c\u1ee7a ERCP, s\u1eed d\u1ee5ng kh\u00e1ng sinh v\u00e0 x\u1eed tr\u00ed d\u1ecbch quanh t\u1ee5y (B\u1ea3ng 50.7).<\/p>\n
$\"\"$ $\"\"$ $\"\"$ $\"\"$ <\/p>\n
Gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n \u0111\u01b0\u1ee3c cho l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh c\u1ee7a gi\u1ea3m t\u01b0\u1edbi m\u00e1u tuy\u1ebfn t\u1ee5y v\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam trong vi\u00eam t\u1ee5y c\u1ea5p. V\u00ec v\u1eady, ph\u1ee5c h\u1ed3i nhanh ch\u00f3ng th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch l\u00e0 li\u1ec7u ph\u00e1p \u0111\u1ea7u ti\u00ean v\u00e0 hi\u1ec7u qu\u1ea3 nh\u1ea5t. H\u1ed3i s\u1ee9c d\u1ecbch duy tr\u00ec th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch trong b\u1ed1i c\u1ea3nh r\u00f2 r\u1ec9 mao m\u1ea1ch l\u01b0\u1ee3ng l\u1edbn li\u00ean quan \u0111\u1ebfn ph\u1ea3n \u1ee9ng vi\u00eam c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p. H\u1ed3i s\u1ee9c d\u1ecbch ng\u0103n ng\u1eeba thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ph\u00e1t tri\u1ec3n ho\u1ea1i t\u1eed tuy\u1ebfn t\u1ee5y, SIRS v\u00e0 suy \u0111a c\u01a1 quan. C\u00e1c khuy\u1ebfn c\u00e1o li\u00ean quan \u0111\u1ebfn t\u1ed1c \u0111\u1ed9, lo\u1ea1i v\u00e0 th\u1eddi gian truy\u1ec1n d\u1ecbch kh\u00e1c nhau v\u00e0 n\u00ean \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n h\u00f3a, m\u1eb7c d\u00f9 h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng vi\u1ec7c b\u00f9 d\u1ecbch s\u1edbm trong v\u00f2ng 24 gi\u1edd \u0111\u1ea7u l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh v\u00e0 t\u1eed vong. N\u00f3i chung, t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam t\u1ee5y c\u1ea5p n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c, nh\u01b0 th\u1ec3 h\u1ecd m\u1eafc b\u1ec7nh n\u1eb7ng, cho \u0111\u1ebfn khi \u0111\u01b0\u1ee3c ch\u1ee9ng minh ng\u01b0\u1ee3c l\u1ea1i. \u00cdt nh\u1ea5t, m\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh t\u1ee5y c\u1ea5p t\u00ednh n\u00ean \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u b\u1eb1ng IVF \u1edf 250 \u0111\u1ebfn 300 mL \/ gi\u1edd \u0111\u1ec3 duy tr\u00ec cung l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u \u1edf m\u1ee9c \u00edt nh\u1ea5t 0,5 mL \/ kg \/ gi\u1edd. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u gi\u1ea3m th\u1ec3 t\u00edch nghi\u00eam tr\u1ecdng, n\u00ean b\u1eaft \u0111\u1ea7u h\u1ed3i s\u1ee9c d\u1ecbch t\u1ed1i \u0111a t\u1eeb 500 \u0111\u1ebfn 1.000 mL \/ gi\u1edd v\u00e0 c\u00f3 th\u1ec3 gi\u1ea3m b\u1edbt m\u1ed9t khi b\u1eb1ng ch\u1ee9ng t\u00ecnh tr\u1ea1ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n. CThe American College of Gastroenterology guidelines khuy\u1ebfn c\u00e1o h\u1ed3i s\u1ee9c d\u1ecbch theo m\u1ee5c ti\u00eau v\u1edbi 250 – 500 ml \/ gi\u1edd d\u1ecbch tinh th\u1ec3 \u0111\u1eb3ng tr\u01b0\u01a1ng trong 12 \u0111\u1ebfn 24 gi\u1edd \u0111\u1ea7u ti\u00ean v\u1edbi \u0111\u00e1nh gi\u00e1 l\u1ea1i th\u01b0\u1eddng xuy\u00ean sau m\u1ed7i 6 gi\u1edd, v\u1edbi m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb l\u00e0 gi\u1ea3m m\u1ee9c BUN t\u1eeb khi gi\u00e1 tr\u1ecb nh\u1eadp vi\u1ec7n. Trong m\u1ed9t nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng lactated ringers (LR) c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u00e1ng k\u1ec3 h\u01a1n trong vi\u1ec7c gi\u1ea3m m\u1ee9c SIRS v\u00e0 CRP so v\u1edbi normal saline. C\u1ea7n l\u01b0u \u00fd tr\u00e1nh s\u1eed d\u1ee5ng LR tr\u00ean b\u1ec7nh nh\u00e2n t\u0103ng calci huy\u1ebft, v\u00ec dung d\u1ecbch n\u00e0y c\u00f3 ch\u1ee9a calci. M\u1eb7c d\u00f9 vi\u1ec7c theo d\u00f5i n\u1ed9i m\u1ea1ch x\u00e2m l\u1ea5n kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o th\u01b0\u1eddng quy, nh\u01b0ng n\u00f3 c\u00f3 th\u1ec3 h\u1eefu \u00edch trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh n\u1eb7ng.<\/p>\n
V\u1edbi tri\u1ec7u ch\u1ee9ng c\u01a1 b\u1ea3n c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 \u0111au b\u1ee5ng d\u1eef d\u1ed9i v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, n\u00ean d\u00f9ng thu\u1ed1c gi\u1ea3m \u0111au d\u1ea1ng thu\u1ed1c opiate ti\u00eam t\u0129nh m\u1ea1ch v\u00e0 c\u00f3 th\u1ec3 c\u1ea7n d\u00f9ng thu\u1ed1c gi\u1ea3m \u0111au th\u00f4ng qua m\u00e1y b\u01a1m \u0111i\u1ec7n (PCA). C\u01a1n \u0111au kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o s\u1ef1 b\u1ea5t \u1ed5n \u0111\u1ecbnh v\u1ec1 huy\u1ebft \u0111\u1ed9ng. Bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n li\u00ean quan \u0111\u1ebfn vi\u00eam t\u1ee5y th\u01b0\u1eddng \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi thu\u1ed1c ch\u1ed1ng n\u00f4n \u0111\u01b0\u1eddng ti\u00eam. B\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam t\u1ee5y nh\u1eb9 n\u00ean b\u1eaft \u0111\u1ea7u \u0103n ngay khi h\u1ecd c\u1ea3m th\u1ea5y c\u00f3 th\u1ec3 v\u00e0 th\u01b0\u1eddng dung n\u1ea1p \u0111\u01b0\u1ee3c ch\u1ebf \u0111\u1ed9 \u0103n \u0111\u1eb7c, \u00edt ch\u1ea5t b\u00e9o trong v\u00f2ng 1 tu\u1ea7n sau khi nh\u1eadp vi\u1ec7n. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam t\u1ee5y n\u1eb7ng, dinh d\u01b0\u1ee1ng qua \u0111\u01b0\u1eddng ru\u1ed9t \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u01a1n so v\u1edbi dinh d\u01b0\u1ee1ng qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Dinh d\u01b0\u1ee1ng \u0111\u01b0\u1eddng ru\u1ed9t b\u1ea3o t\u1ed3n ni\u00eam m\u1ea1c ru\u1ed9t v\u00e0 do \u0111\u00f3 c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 vi khu\u1ea9n d\u1ecbch chuy\u1ec3n t\u1eeb ru\u1ed9t v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng sau \u0111\u00f3. Dinh d\u01b0\u1ee1ng \u0111\u01b0\u1eddng ru\u1ed9t c\u00f3 li\u00ean quan \u0111\u1ebfn gi\u1ea3m nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch trung t\u00e2m, nhi\u1ec5m tr\u00f9ng huy\u1ebft, c\u1ea7n can thi\u1ec7p ph\u1eabu thu\u1eadt, th\u1eddi gian n\u1eb1m vi\u1ec7n v\u00e0 chi ph\u00ed khi so s\u00e1nh v\u1edbi dinh d\u01b0\u1ee1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Kh\u00f4ng c\u00f3 s\u1ef1 th\u1ed1ng nh\u1ea5t v\u1ec1 \u0111\u01b0\u1eddng dinh d\u01b0\u1ee1ng qua \u0111\u01b0\u1eddng ru\u1ed9t \u01b0a th\u00edch, v\u00ed d\u1ee5, \u0111\u01b0\u1eddng mi\u1ec7ng so v\u1edbi \u1ed1ng th\u00f4ng d\u1ea1 d\u00e0y. M\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 g\u1ea7n \u0111\u00e2y \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng vi\u1ec7c nu\u00f4i \u0103n s\u1edbm qua sonde d\u1ea1 d\u00e0y kh\u00f4ng kh\u00e1c g\u00ec ch\u1ebf \u0111\u1ed9 \u0103n \u0111\u01b0\u1eddng mi\u1ec7ng b\u1eaft \u0111\u1ea7u t\u1eeb 72 gi\u1edd trong vi\u1ec7c gi\u1ea3m t\u1ef7 l\u1ec7 nhi\u1ec5m tr\u00f9ng ho\u1eb7c t\u1eed vong \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam t\u1ee5y c\u1ea5p c\u00f3 nguy c\u01a1 bi\u1ebfn ch\u1ee9ng cao.<\/p>\n
Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 vi\u00eam t\u1ee5y s\u1ecfi m\u1eadt, n\u00ean b\u1eaft \u0111\u1ea7u d\u00f9ng kh\u00e1ng sinh v\u00e0 ti\u1ebfn h\u00e0nh gi\u1ea3i \u00e1p \u0111\u01b0\u1eddng m\u1eadt qua ERCP s\u1edbm (trong v\u00f2ng 72 gi\u1edd \u0111\u1ea7u) n\u1ebfu nghi ng\u1edd c\u00f3 vi\u00eam \u0111\u01b0\u1eddng m\u1eadt t\u0103ng d\u1ea7n. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u1edbi thu\u1ed1c an th\u1ea7n ho\u1eb7c kh\u00f4ng c\u00f3 ERCP, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n ch\u1ee5p \u0111\u01b0\u1eddng m\u1eadt qua da (PTC) c\u00f3 \u0111\u1eb7t catheter. ERCP s\u1edbm \u00edt \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ti\u1ebfn tr\u00ecnh c\u1ee7a vi\u00eam t\u1ee5y, nh\u01b0ng l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh li\u00ean quan \u0111\u1ebfn vi\u00eam \u0111\u01b0\u1eddng m\u1eadt \u0111\u1ed3ng th\u1eddi. N\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam t\u1ee5y c\u1ea5p c\u00f3 men gan b\u1ea5t th\u01b0\u1eddng v\u00e0 t\u00fai m\u1eadt c\u00f2n nguy\u00ean v\u1eb9n, n\u00ean ch\u1ecdc t\u00fai m\u1eadt trong c\u00f9ng th\u1eddi gian n\u1eb1m vi\u1ec7n ho\u1eb7c trong v\u00f2ng 30 ng\u00e0y k\u1ec3 t\u1eeb ng\u00e0y xu\u1ea5t vi\u1ec7n \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t vi\u00eam t\u1ee5y c\u1ea5p. M\u1ed9t ERCP v\u1edbi biliaiy sphincteroromy n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt. N\u00f3i chung, vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh d\u1ef1 ph\u00f2ng th\u01b0\u1eddng quy kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng. Thu\u1ed1c kh\u00e1ng sinh \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb n\u1ebfu c\u00f3 lo ng\u1ea1i vi\u00eam \u0111\u01b0\u1eddng m\u1eadt \u0111\u1ed3ng th\u1eddi ho\u1eb7c c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng kh\u00e1c \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn. Trong giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a b\u1ec7nh, b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng c\u00f3 th\u1ec3 s\u1ed1t v\u00e0 t\u0103ng b\u1ea1ch c\u1ea7u do vi\u00eam li\u00ean quan \u0111\u1ebfn vi\u00eam t\u1ee5y, v\u00e0 kh\u00e1ng sinh kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ea3o \u0111\u1ea3m cho nh\u1eefng d\u1ea5u hi\u1ec7u n\u00e0y. Kh\u00e1ng sinh kh\u00f4ng n\u00ean ti\u00eam th\u01b0\u1eddng quy trong vi\u00eam t\u1ee5y c\u1ea5p ho\u1ea1i t\u1eed, v\u00ec ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng mu\u1ed9n, th\u01b0\u1eddng x\u1ea3y ra \u00edt nh\u1ea5t 2 tu\u1ea7n sau khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng. Nh\u00ecn chung, Kh\u00e1ng sinh c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m c\u00e1c bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng nh\u01b0ng kh\u00f4ng ch\u1ee9ng minh l\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh l\u00e0 th\u00edch h\u1ee3p cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn v\u00e0 \/ ho\u1eb7c ch\u1ecdc h\u00fat b\u1eb1ng kim nh\u1ecf \u0111\u1ec3 t\u00ecm ho\u1ea1i t\u1eed t\u1ee5y bi\u1ec3u hi\u1ec7n t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng. C\u00e1c lo\u1ea1i kh\u00e1ng sinh \u01b0u ti\u00ean cho ho\u1ea1i t\u1eed t\u1ee5y l\u00e0 carbapenems, quinolon, ho\u1eb7c metronidazole v\u00ec nh\u1eefng kh\u00e1ng sinh n\u00e0y th\u00e2m nh\u1eadp v\u00e0o tuy\u1ebfn t\u1ee5y ho\u1ea1i t\u1eed. Probiotics kh\u00f4ng c\u00f3 vai tr\u00f2 trong \u0111i\u1ec1u tr\u1ecb vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng.<\/p>\n
C\u00e1c bi\u1ebfn ch\u1ee9ng t\u1ea1i ch\u1ed7 c\u1ee7a vi\u00eam t\u1ee5y c\u1ea5p bao g\u1ed3m t\u1ee5 d\u1ecbch quanh t\u1ee5y, nang gi\u1ea3 t\u1ee5y, t\u1ee5 d\u1ecbch ho\u1ea1i t\u1eed v\u00e0 ho\u1ea1i t\u1eed c\u00f3 v\u00e1ch ng\u0103n (B\u1ea3ng 50.8). T\u1ee5 d\u1ecbch c\u1ea5p t\u00ednh (d\u1ecbch t\u1ee5y gi\u00e0u enzym v\u00e0 c\u00e1c m\u1ea3nh v\u1ee5n m\u00f4 trong v\u00e0 xung quanh tuy\u1ebfn t\u1ee5y) x\u1ea3y ra \u1edf 40% b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam t\u1ee5y c\u1ea5p n\u1eb7ng. Ch\u00fang \u0111\u1ea1i di\u1ec7n cho m\u1ed9t ph\u1ea3n \u1ee9ng huy\u1ebft thanh ho\u1eb7c d\u1ecbch ti\u1ebft \u0111\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng v\u00e0 vi\u00eam t\u1ee5y. C\u00f3 r\u1ea5t \u00edt vai tr\u00f2 trong vi\u1ec7c d\u1eabn l\u01b0u c\u00e1c \u1ed5 t\u1ee5 d\u1ecbch c\u1ea5p t\u00ednh tr\u1eeb khi c\u00f3 h\u1ed9i ch\u1ee9ng khoang b\u1ee5ng, t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra d\u1ea1 d\u00e0y nghi\u00eam tr\u1ecdng ho\u1eb7c nghi ng\u1edd nhi\u1ec5m tr\u00f9ng s\u1edbm. Ph\u1ea7n l\u1edbn c\u00e1c t\u1ee5 d\u1ecbch c\u1ea5p t\u00ednh gi\u1ea3i quy\u1ebft m\u1ed9t c\u00e1ch t\u1ef1 nhi\u00ean. C\u00e1c t\u1ee5 d\u1ecbch n\u00e0y thi\u1ebfu c\u00e1c v\u00e1ch ng\u0103n c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c v\u00e0 do \u0111\u00f3 kh\u00f4ng th\u1ec3 can thi\u1ec7p b\u1eb1ng n\u1ed9i soi v\u00e0 c\u1ea7n d\u1eabn l\u01b0u qua da khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/p>\n
T\u1ee5 d\u1ecbch t\u1ed3n t\u1ea1i d\u1ea7n d\u1ea7n bao b\u1ecdc trong v\u00f2ng 4 \u0111\u1ebfn 6 tu\u1ea7n v\u00e0 bao g\u1ed3m m\u1ed9t lo\u1ea1t c\u00e1c t\u1ee5 d\u1ecbch kh\u00e1c nhau, t\u1eeb c\u00e1c nang gi\u1ea3 h\u1ea7u h\u1ebft l\u00e0 d\u1ecbch (kh\u00f4ng ho\u1ea1i t\u1eed) \u0111\u1ebfn ho\u1ea1i t\u1eed t\u1ee5y c\u00f3 v\u00e1ch (WOPN) ch\u1ee9a nhi\u1ec1u m\u1ea3nh v\u1ee5n ho\u1ea1i t\u1eed kh\u00e1c nhau. D\u1eabn l\u01b0u n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ho\u1ea1i t\u1eed v\u00f4 khu\u1ea9n tr\u1edf n\u00ean c\u00f3 tri\u1ec7u ch\u1ee9ng (v\u00ed d\u1ee5, \u0111au, t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra d\u1ea1 d\u00e0y) ho\u1eb7c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi kh\u00e1ng sinh.<\/p>\n
$\"B\u1ea3ng$
B\u1ea3ng 50.8<\/figcaption><\/figure>\n
\u0110i\u1ec1u tr\u1ecb ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng d\u1ef1a tr\u00ean di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n, v\u00e0 ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng n\u00ean \u0111\u01b0\u1ee3c nghi ng\u1edd \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ho\u1ea1i t\u1eed t\u1ee5y c\u00f3 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng x\u1ea5u \u0111i. Nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u1edbi ho\u1ea1i t\u1eed nhi\u1ec5m tr\u00f9ng ho\u1eb7c h\u1ed9i ch\u1ee9ng khoang b\u1ee5ng th\u01b0\u1eddng ph\u1ea3i d\u1eabn l\u01b0u. Theo truy\u1ec1n th\u1ed1ng, \u0111i\u1ec1u n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u1edbi ph\u1eabu thu\u1eadt n\u1ed9i soi th\u0103m d\u00f2, \u0111\u1eb7t \u1ed1ng d\u1eabn l\u01b0u, nh\u01b0ng c\u00f3 li\u00ean quan \u0111\u1ebfn t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh v\u00e0 t\u1eed vong cao. Hi\u1ec7n \u0111\u00e3 c\u00f3 b\u1eb1ng ch\u1ee9ng thuy\u1ebft ph\u1ee5c r\u1eb1ng n\u1ed9i soi ho\u1eb7c d\u1eabn l\u01b0u qua da gi\u00fap t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh v\u00e0 t\u1eed vong th\u1ea5p h\u01a1n so v\u1edbi ph\u1eabu thu\u1eadt m\u1edf;<\/p>\n
T\u00d3M T\u1eaeT<\/h2>\n
Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p ph\u1ea3i nh\u1eadp vi\u1ec7n v\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh v\u00e0 t\u1eed vong cao. Nhi\u1ec1u h\u1ec7 th\u1ed1ng t\u00ednh \u0111i\u1ec3m \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh v\u00e0 \u0111i\u1ec1u tr\u1ecb tr\u1ef1c ti\u1ebfp. Ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 x\u1eed tr\u00ed t\u00edch c\u1ef1c v\u1edbi d\u1ecbch truy\u1ec1n t\u0129nh m\u1ea1ch, ki\u1ec3m so\u00e1t \u0111au v\u00e0 cho \u0103n s\u1edbm l\u00e0 \u0111i\u1ec1u t\u1ed1i quan tr\u1ecdng \u0111\u1ec3 c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n
T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n
\n
AI-Omran M, Albalawi ZH, Tashkandi MF, et al. Enteral versus parenteral nutrition for acute pancreatitis. Cochrane Database Syst Rev. 2010;20;(1):CD002837.<\/li>\n
Bakker J, Van Brunschot S, Van Santvoort J, et al. Early versus on-demand nasoenteric tube feeding in acute pancreatitis. NEJM. 2014;371:1983-1993.<\/li>\n
Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revisions of che Atlanta classification and definitions by international consensus. Gut. 2013;62: 102-111.<\/li>\n
Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. AmJ Castro. 2006;101 :2379-2400.<\/li>\n
Greer SE, Burchard KW Acute pancreatitis and critical illness: a pancreatic tale ofhypoperfusion and inflammation. Chest. 2009;136:1413-1419.<\/li>\n
Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ 2014;12:349-357.<\/li>\n
Pando! SJ, Saluja AK, Imrie CW, et al. Acute pancreatitis: bench co bedside. Gastroenterology. 2007;132:1127-1151.<\/li>\n
Papachrisrou GI, MuddanaV, Yadav D , et al. Comparison ofBISAP, Ranson’s, APACHEII, and CTSl scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am} Gastroenterof. 2010;105(2):435-441; quiz 442.<\/li>\n
Pezzilli R, Zerbi A, DiCarlo V, et al. Practical guidelines for acute pancreatitis. Pancreatology. 2010;10:523-535.<\/li>\n
Tenner S, Baillie J, DeWitt J, et al. Management of acute pancreatitis. Am J Gastroenterof. 2013; 108:1400-1415.<\/li>\n
Van Santvoorc H C, Besselink MG, Bakker OJ, et al. A seep-up approach or open necrosectomy for necrotizing pancreatitis. NEJM. 2010;362: 1491-1502.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u0110\u1ec3 t\u1ea3i file PDF b\u00e0i vi\u1ebft Vi\u00eam T\u1ee5y C\u1ea5p, m\u1eddi c\u00e1c b\u1ea1n click v\u00e0o \u0111\u01b0\u1eddng link t\u1ea1i \u0111\u00e2y B\u1ea3n D\u1ecbch C\u1ee7a B\u00e1c S\u0129 Tr\u1ea7n Minh Th\u00e0nh- Khoa HSTC-C\u0110 \u0110\u1eb6T V\u1ea4N \u0110\u1ec0 Vi\u00eam t\u1ee5y c\u1ea5p l\u00e0 l\u00fd do ph\u1ed5 […]\n","protected":false},"author":1,"featured_media":32979,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-32971","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\/32971","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=32971"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/32971\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/32979"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=32971"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=32971"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=32971"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}