{"id":33750,"date":"2022-08-23T00:34:17","date_gmt":"2022-08-22T17:34:17","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=33750"},"modified":"2022-08-23T00:34:39","modified_gmt":"2022-08-22T17:34:39","slug":"ton-thuong-than-cap-dieu-tri-trong-y-hoc","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/ton-thuong-than-cap-dieu-tri-trong-y-hoc\/","title":{"rendered":"T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p \u0111i\u1ec1u tr\u1ecb trong y h\u1ecdc"},"content":{"rendered":"

T\u00e1c gi\u1ea3: Fahad Edrees and Anitha Vijayan<\/em><\/p>\n

Bi\u00ean d\u1ecbch: B\u00e1c s\u0129 Ho\u00e0ng Nam<\/em><\/p>\n

vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p \u0111i\u1ec1u tr\u1ecb trong y h\u1ecdc<\/strong><\/a>, xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y<\/a>.<\/p>\n

T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p (AKI), tr\u01b0\u1edbc \u0111\u00e2y g\u1ecdi l\u00e0 suy th\u1eadn c\u1ea5p, l\u00e0 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m nhanh ch\u00f3ng ch\u1ee9c n\u0103ng th\u1eadn th\u01b0\u1eddng g\u1eb7p l\u00e0 gi\u1ea3m l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u v\u00e0 t\u00edch t\u1ee5 c\u00e1c s\u1ea3n ph\u1ea9m cu\u1ed1i c\u00f9ng c\u1ee7a qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a nitrogen. \u0110\u00e2y l\u00e0 b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p tr\u00ean b\u1ec7nh nh\u00e2n n\u1eb7ng, th\u01b0\u1eddng suy \u0111a c\u01a1 quan v\u00e0 l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong t\u1ea1i b\u1ec7nh vi\u1ec7n v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong l\u00e2u d\u00e0i. Trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m, t\u1ef7 l\u1ec7 m\u1eafc AKI t\u1ea1i \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c (ICU) l\u00e0 57%, v\u1edbi nhi\u1ec5m tr\u00f9ng huy\u1ebft \u0111\u01b0\u1ee3c xem l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a 41% c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y.<\/p>\n

\u0110\u1ecbnh ngh\u0129a<\/h2>\n
Vi\u1ec7c thi\u1ebfu th\u1ed1ng nh\u1ea5t \u0111\u1ecbnh ngh\u0129a AKI l\u00e0m nh\u1ea7m l\u1eabn c\u00e1c so s\u00e1nh gi\u1eefa nghi\u00ean c\u1ee9u d\u1ef1 ph\u00f2ng, \u0111i\u1ec1u tr\u1ecb v\u00e0 k\u1ebft c\u1ee5c. Hi\u1ec7n nay, ti\u00eau chu\u1ea9n RIFLE (nguy c\u01a1, t\u1ed5n th\u01b0\u01a1ng, suy, m\u1ea5t ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i) v\u00e0 ti\u00eau chu\u1ea9n h\u1ec7 th\u1ed1ng t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p (AKIN) \u0111\u01b0\u1ee3c thay th\u1ebf b\u1eb1ng B\u1ec7nh th\u1eadn: c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c to\u00e0n c\u1ea7u giai \u0111o\u1ea1n AKI (KDIGO) (b\u1ea3ng 43.1) – \u0111\u01b0a ra m\u1ed9t \u0111\u1ecbnh ngh\u0129a chung trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, nghi\u00ean c\u1ee9u v\u00e0 c\u00f4ng b\u1ed1 c\u00e1c c\u00f4ng tr\u00ecnh nghi\u00ean c\u1ee9u s\u1ee9c kh\u1ecfe.<\/p>\n
H\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng KDIGO \u0111\u1ed1i v\u1edbi AKI bao g\u1ed3m m\u1ed9t s\u1eeda \u0111\u1ed5i \u0111\u1ecbnh ngh\u0129a AKI trong khi v\u1eabn gi\u1eef nguy\u00ean ti\u00eau chu\u1ea9n ph\u00e2n chia giai \u0111o\u1ea1n AKIN. V\u1eabn gi\u1eef khung tham chi\u1ebfu t\u0103ng creatinin huy\u1ebft thanh \u2265 0.3 mg\/dl, trong khi khung th\u1eddi gian t\u0103ng creatinin huy\u1ebft thanh \u2265 1.5 l\u1ea7n \u0111\u01b0\u1ee3c thay \u0111\u1ed5i l\u00ean 7 ng\u00e0y.<\/p>\n
B\u1ec7nh nh\u00e2n AKI th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e2n chia th\u00e0nh kh\u00f4ng thi\u1ec3u ni\u1ec7u (l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u \u2265 400 ml\/ng\u00e0y), thi\u1ec3u ni\u1ec7u (l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u <400 ml\/ng\u00e0y) ho\u1eb7c v\u00f4 ni\u1ec7u (l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u <100 ml\/ng\u00e0y). Th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u th\u1ea5p n\u00ean nghi ng\u1edd c\u00f3 t\u00ecnh tr\u1ea1ng suy th\u1eadn n\u1eb7ng v\u00e0 li\u00ean quan k\u1ebft c\u1ee5c ngh\u00e8o n\u00e0n. Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn c\u0169ng c\u00f3 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u. Do \u0111\u00f3, ch\u1ea9n \u0111o\u00e1n k\u1ecbp th\u1eddi c\u1ef1c k\u1ef3 quan tr\u1ecdng, x\u00e1c \u0111\u1ecbnh v\u00e0 \u0111i\u1ec1u tr\u1ecb nhanh ch\u00f3ng c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y suy t\u1ed5n th\u01b0\u01a1ng th\u1eadn gi\u00fap \u0111\u1ea9y nhanh qu\u00e1 tr\u00ecnh h\u1ed3i ph\u1ee5c v\u00e0 tr\u00e1nh l\u1ecdc m\u00e1u.<\/p>\n
Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u00e2n t\u1ed5n th\u01b0\u01a1ng th\u00e2n c\u1ea5p (AKI)<\/p>\n
AKI l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng do nhi\u1ec1u nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh. S\u1eed d\u1ee5ng s\u01a1 \u0111\u1ed3 ti\u1ebfp c\u1eadn \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 AKI, b\u01b0\u1edbc quan tr\u1ecdng \u0111\u1ea7u ti\u00ean trong qu\u00e1 tr\u00ecnh n\u00e0y l\u00e0 x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng tr\u01b0\u1edbc th\u1eadn, t\u1ea1i th\u1eadn hay sau th\u1eadn (s\u01a1 \u0111\u1ed3 43.1). Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, khai th\u00e1c b\u1ec7nh s\u1eed, kh\u00e1m l\u00e2m s\u00e0ng, th\u00f4ng tin t\u1eeb c\u1eadn l\u00e2m s\u00e0ng\/h\u00ecnh \u1ea3nh Xquang v\u00e0 \u0111\u00e1nh gi\u00e1 k\u1ef9 c\u00e0ng b\u1ec7nh \u00e1n s\u1ebd cung c\u1ea5p d\u1eef li\u1ec7u c\u1ea7n thi\u1ebft gi\u00fap th\u00e0nh l\u1eadp ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh. Tuy nhi\u00ean, nguy\u00ean nh\u00e2n AKI ph\u1ed5 bi\u1ebfn nh\u1ea5t trong ICU l\u00e0 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng nhi\u1ec5m \u0111\u1ed9c, th\u01b0\u1eddng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p (ATN).<\/p>\n\n\n\n\n\n\n\n
B\u1ea2NG 43.1<\/td>\n Ph\u00e2n giai \u0111o\u1ea1n AKI theo KDIGO<\/td>\n<\/tr>\n
Giai \u0111o\u1ea1n<\/td>\n Creatinine huy\u1ebft thanh<\/td>\n Th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u<\/td>\n<\/tr>\n
1<\/td>\n g\u1ea5p 1.5\u20131.9 l\u1ea7n creatinin n\u1ec1n HO\u1eb6C<\/p>\n
T\u0103ng \u22650.3 mg\/dL<\/td>\n
<0.5 mL\/kg\/h trong 6\u201312h<\/td>\n<\/tr>\n
2<\/td>\n g\u1ea5p 2.0\u20132.9 l\u1ea7n creatinin n\u1ec1n<\/td>\n <0.5 mL\/kg\/h trong \u226512 h<\/td>\n<\/tr>\n
3<\/td>\n g\u1ea5p 3.0 l\u1ea7n creatinin n\u1ec1n HO\u1eb6C<\/p>\n
T\u0103ng creatinin huy\u1ebft thanh \u22654.0 mg\/dL<\/p>\n
HO\u1eb6C<\/p>\n
B\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn<\/td>\n
<0.3 mL\/kg\/h trong \u226524h<\/p>\n
HO\u1eb6C<\/p>\n
V\u00f4 ni\u1ec7u \u226512 h<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ch\u1ec9 m\u1ed9t ti\u00eau chu\u1ea9n (creatinin ho\u1eb7c th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u) \u0111\u1ec3 \u0111\u00e1p \u1ee9ng \u0111\u1ee7 ti\u00eau chu\u1ea9n cho 1 giai \u0111o\u1ea1n.<\/p>\n
KDIGO, B\u1ec7nh th\u1eadn: c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c to\u00e0n c\u1ea7u.<\/h2>\n
N\u00ean t\u1eadp trung khai th\u00e1c b\u1ec7nh s\u1eed v\u1ec1 c\u00e1c bi\u1ebfn c\u1ed1 g\u1ea7n \u0111\u00e2y c\u00f3 th\u1ec3 gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn ho\u1eb7c ti\u1ebfp x\u00fac g\u1ea7n \u0111\u00e2y v\u1edbi c\u00e1c \u0111\u1ed9c t\u1ed1 th\u1eadn, c\u1ea3 n\u1ed9i sinh v\u00e0 ngo\u1ea1i sinh. Ph\u1ea3i x\u00e1c \u0111\u1ecbnh c\u00e1c nguy\u00ean nh\u00e2n gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn (nh\u01b0 suy gi\u1ea3m th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch, gi\u1ea3m cung l\u01b0\u1ee3ng tim, s\u1ed1c, x\u01a1 gan v\u00e0 nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c l\u00e0m co m\u1ea1ch th\u1eadn). Ch\u1ea5n th\u01b0\u01a1ng g\u1ea7n \u0111\u00e2y l\u00e0m gia t\u0103ng nghi ng\u1edd ATN do myoglobin. Bi\u1ec3u hi\u1ec7n \u1edf ph\u1ed5i nh\u01b0 kh\u00f3 th\u1edf v\u00e0 ho ra m\u00e1u l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng m\u1eafc h\u1ed9i ch\u1ee9ng gan ph\u1ed5i nh\u01b0 b\u1ec7nh Goodpasture v\u00e0 u h\u1ea1t v\u1edbi vi\u00eam \u0111a m\u1ea1ch (GPA). B\u1ec7nh s\u1eed c\u00f3 s\u1ed1t, ph\u00e1t ban v\u00e0 \u0111au kh\u1edbp c\u00f3 th\u1ec3 g\u1ee3i \u00fd vi\u00eam m\u1ea1ch ho\u1eb7c m\u1ed9t b\u1ec7nh nguy\u00ean nhi\u1ec5m tr\u00f9ng (nh\u01b0 vi\u00eam m\u00e0ng ngo\u00e0i tim). \u0110au m\u1ea1n s\u01b0\u1eddn c\u00f3 th\u1ec3 do s\u1ecfi th\u1eadn, t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ti\u1ec3u, huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch th\u1eadn ho\u1eb7c nh\u1ed3i m\u00e1u th\u1eadn. Xu\u1ea5t hi\u1ec7n ho\u1eb7c kh\u00f4ng c\u00f3 v\u00f4 ni\u1ec7u ho\u1eb7c ti\u1ec3u m\u00e1u c\u0169ng r\u1ea5t quan tr\u1ecdng. Khai th\u00e1c chi ti\u1ebft b\u1ec7nh s\u1eed v\u00e0 ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c g\u1ea7n \u0111\u00e2y (nh\u01b0 kh\u00e1ng sinh, kh\u00e1ng vi\u00eam non-steroide [NSAIDS], l\u1ee3i ti\u1ec3u v\u00e0 c\u00e1c thu\u1ed1c h\u00f3a tr\u1ecb), g\u1ed3m c\u1ea3 c\u00e1c thu\u1ed1c kh\u00f4ng k\u00ea \u0111\u01a1n v\u00e0 thu\u1ed1c c\u1ea3n quang. Trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb AKI sau m\u1ed5, n\u00ean x\u00e9m x\u00e9t c\u1ea9n th\u1eadn t\u01b0\u1eddng tr\u00ecnh ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 cho, bi\u1ebft c\u00e1c \u0111\u1ee3t h\u1ea1 huy\u1ebft \u00e1p ho\u1eb7c s\u1eed d\u1ee5ng thu\u1ed1c g\u00e2y \u0111\u1ed9c th\u1eadn. Tr\u00ean b\u1ec7nh nh\u00e2n n\u1eb1m vi\u1ec7n \u0111i\u1ec1u tr\u1ecb, c\u1ea7n t\u00ecm c\u00e1c y\u1ebfu t\u1ed1 l\u00e0m thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ho\u1eb7c g\u00e2y \u0111\u1ed9c th\u1eadn. \u1ede b\u1ec7nh nh\u00e2n thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i t\u00e2m th\u1ea7n, ph\u1ea3i thu th\u1eadp b\u1ec7nh s\u1eed t\u1eeb c\u00e1c th\u00e0nh vi\u00ean trong gia \u0111\u00ecnh ho\u1eb7c b\u1ea1n b\u00e8 v\u00ec gi\u00fap cung c\u1ea5p manh m\u1ed1i d\u00f9ng qu\u00e1 li\u1ec1u thu\u1ed1c (nh\u01b0 acetaminophen hay c\u00e1c thu\u1ed1c kh\u00e1c) ho\u1eb7c v\u00f4 t\u00ecnh hay c\u1ed1 \u00fd nu\u1ed1t ph\u1ea3i (nh\u01b0 ethylene glycol ho\u1eb7c methanol).<\/p>\n
Kh\u00e1m l\u00e2m s\u00e0ng, \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u c\u1ee7a b\u1ec7nh nh\u00e2n s\u1ebd gi\u00fap thu \u0111\u01b0\u1ee3c b\u1eb1ng ch\u1ee9ng quan tr\u1ecdng v\u1ec1 b\u1ea3n ch\u1ea5t v\u00e0 m\u1ee9c \u0111\u1ed9 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn. C\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 to\u00e0n th\u00e2n nh\u01b0 vi\u00eam kh\u1edbp, ph\u00e1t ban v\u00e0 tr\u1ea1ng th\u00e1i t\u00e2m th\u1ea7n c\u0169ng cho bi\u1ebft c\u00e1c manh m\u1ed1i c\u00f3 gi\u00e1 tr\u1ecb li\u00ean quan \u0111\u1ebfn nh\u1eefng b\u1ec7nh to\u00e0n th\u00e2n nh\u01b0 nhi\u1ec5m tr\u00f9ng, vi\u00eam m\u1ea1ch, b\u1ec7nh thuy\u00ean t\u1eafc x\u01a1 v\u1eefa ho\u1eb7c huy\u1ebft kh\u1ed1i vi m\u1ea1ch. Kh\u00e1m th\u1ea5y b\u1ee5ng ch\u01b0\u1edbng l\u00ean t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra b\u00e0ng quang r\u1ea5t c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n AKI. B\u1ee5ng r\u1ea5t c\u0103ng v\u00e0 ch\u01b0\u1edbng l\u00ean trong \u0111i\u1ec1u tr\u1ecb c\u1ed5 tr\u01b0\u1edbng ho\u1eb7c ph\u1eabu thu\u1eadt \u1ed5 b\u1ee5ng g\u1ea7n \u0111\u00e2y l\u00e0m t\u0103ng nghi ng\u1edd h\u1ed9i ch\u1ee9ng khoang b\u1ee5ng.<\/p>\n
N\u00ean l\u00e0m th\u00eam c\u00e1c c\u1eadn l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh Xquang nh\u01b0 c\u00f4ng th\u1ee9c m\u00e1u, c\u00e1c th\u00f4ng s\u1ed1 ch\u1ee9c n\u0103ng th\u1eadn, t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u, soi k\u00ednh hi\u1ec3n vi c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u, t\u00ednh t\u1ef7 s\u1ed1 b\u00e0i ti\u1ebft natri (FENa) v\u00e0 ure (FEUrea). N\u1ebfu nghi ng\u1edd c\u00f3 t\u1eafc ngh\u1ebdn th\u00ec n\u00ean si\u00eau \u00e2m th\u1eadn. D\u1ef1a tr\u00ean nh\u1eefng c\u00e2n nh\u1eafc ban \u0111\u1ea7u, c\u00f3 th\u1ec3 l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m b\u1ed5
\nsung \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n nh\u01b0 huy\u1ebft thanh h\u1ecdc ho\u1eb7c si\u00eau \u00e2m Doppler th\u1eadn. Sinh thi\u1ebft th\u1eadn r\u1ea5t c\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n n\u1ebfu nghi ng\u1edd vi\u00eam c\u1ea7u th\u1eadn v\u00e0 c\u0169ng d\u00f9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh vi\u00eam th\u1eadn k\u1ebd.Ch\u1ea9n \u0111o\u00e1n ATN n\u00ean d\u1ef1a v\u00e0o b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 c\u1eadn l\u00e2m s\u00e0ng \u1ee7ng h\u1ed9.<\/p>\n
$\"S\u01a0$
S\u01a0 \u0110\u1ed2 43.1: \u0110\u1eb7c \u0111i\u1ec3m ph\u00e2n bi\u1ec7t 3 lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p<\/figcaption><\/figure>\n
<\/p>\n
<\/p>\n
Th\u00e0nh ph\u1ea7n h\u00f3a h\u1ecdc c\u1ee7a n\u01b0\u1edbc ti\u1ec3u<\/h2>\n
T\u1ef7 s\u1ed1 b\u00e0i ti\u1ebft Natri (FENa)<\/h3>\n
FENa d\u1ef1a tr\u00ean ti\u1ec1n \u0111\u1ec1 l\u00e0 \u1ed1ng th\u1eadn c\u00f2n nguy\u00ean v\u1eb9n s\u1ebd t\u00e1i h\u1ea5p thu natri trong khi \u0111\u00f3 t\u1ed5n th\u01b0\u01a1ng \u1ed1ng th\u1eadn nh\u01b0 trong b\u1ec7nh ATN th\u00ec s\u1ebd kh\u00f4ng th\u1ec3 t\u00e1i h\u1ea5p thu natri. H\u00e3y ch\u00fa \u00fd v\u1ea5n \u0111\u1ec1 sinh l\u00fd quan tr\u1ecdng n\u00e0y v\u00ec FENa r\u1ea5t h\u1eefu \u00edch tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1eb7c bi\u1ec7t v\u00e0 c\u00e1c t\u00ecnh hu\u1ed1ng l\u00e2m s\u00e0ng nh\u1ea5t \u0111\u1ecbnh, \u0111\u1eb7c bi\u1ec7t l\u00e0 AKI thi\u1ec3u ni\u1ec7u \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng d\u00f9ng l\u1ee3i ti\u1ec3u ho\u1eb7c truy\u1ec1n t\u0129nh m\u1ea1ch dung d\u1ecbch ch\u1ee9a mu\u1ed1i v\u00e0 kh\u00f4ng c\u00f3 b\u1ec7nh th\u1eadn m\u1ea1n (CKD), ti\u1ec3u ra glucose ho\u1eb7c ti\u1ec3u bicarbonate. \u0110\u00e1nh gi\u00e1 FENa <1% c\u00f3 th\u1ec3 g\u1eb7p tr\u00ean nhi\u1ec1u b\u1ec7nh th\u1eadn kh\u00e1c, g\u1ed3m vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p, b\u1ec7nh th\u1eadn do thu\u1ed1c c\u1ea3n quang, ATN do ch\u1ea5t nhu\u1ed9m m\u00e0u, th\u1ea3i gh\u00e9p v\u00e0 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ni\u1ec7u giai \u0111o\u1ea1n s\u1edbm. Tr\u00ean b\u1ec7nh nh\u00e2n suy gi\u1ea3m kh\u1ea3 n\u0103ng c\u00f4 \u0111\u1eb7c n\u01b0\u1edbc ti\u1ec3u (CKD ho\u1eb7c b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i), FENa c\u00f3 th\u1ec3 >1% trong b\u1ec7nh c\u1ea3nh tr\u01b0\u1edbc th\u1eadn. Nh\u00ecn chung trong b\u1ea5t k\u1ef3 b\u1ec7nh n\u00e0o l\u00e0m r\u1ed1i lo\u1ea1n ph\u1ea3n \u1ee9ng t\u00e1i h\u1ea5p thu natri \u0111\u1ec1u c\u00f3 th\u1ec3 l\u00e0m FENa k\u00e9m ph\u1ea3n x\u1ea1 v\u1edbi nguy\u00ean nh\u00e2n th\u1eadt s\u1ef1 c\u1ee7a AKI. Tuy nhi\u00ean, FENa kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ee9ng
\nminh l\u00e0 h\u1eefu \u00edch \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ho\u1eb7c ti\u00ean l\u01b0\u1ee3ng tr\u00ean b\u1ec7nh nh\u00e2n n\u1eb7ng v\u00e0 n\u00ean d\u00f9ng th\u1eadn tr\u1ecdng trong ICU.<\/p>\n
T\u1ef7 s\u1ed1 b\u00e0i ti\u1ebft Ure<\/h3>\n
T\u00e1i h\u1ea5p thu ure \u00edt \u1ea3nh h\u01b0\u1edfng b\u1edfi thu\u1ed1c l\u1ee3i ti\u1ec3u, t\u00e1c \u0111\u1ed9ng \u1edf ph\u00eda xa \u1ed1ng l\u01b0\u1ee3n g\u1ea7n. FEUre <35% ph\u1ea3n \u00e1nh AKI tr\u01b0\u1edbc th\u1eadn, trong khi \u0111\u00f3 >50% ph\u1ea3n \u00e1nh m\u1ea5t ch\u1ee9c n\u0103ng \u1ed1ng th\u1eadn do ATN. Nhi\u1ec1u nghi\u00ean c\u1ee9u ch\u1ec9 ra \u0111\u1ed9 nh\u1ea1y (68%-90%) v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u (48%-96%) kh\u00e1c nhau. C\u00e1c y\u1ebfu t\u1ed1 t\u01b0\u01a1ng t\u1ef1 nh\u01b0 tu\u1ed5i gi\u00e0, \u1ed1m y\u1ebfu, c\u00f3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc s\u1ebd \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn gi\u00e1 tr\u1ecb c\u1ee7a FENa c\u0169ng nh\u01b0 FEUrea. M\u1ed9t nghi\u00ean c\u1ee9u \u0111\u00e3 d\u00f9ng FEUrea <40% nh\u01b0 \u0111i\u1ec3m c\u1eaft AKI tr\u01b0\u1edbc th\u1eadn tr\u00ean b\u1ec7nh nh\u00e2n AKI thi\u1ec3u ni\u1ec7u. X\u00e9t nghi\u1ec7m FEUrea < 40% t\u00ecm th\u1ea5y trong AKI tr\u01b0\u1edbc th\u1eadn th\u1eadm ch\u00ed c\u00f3 d\u00f9ng l\u1ee3i ti\u1ec3u (ch\u00ednh x\u00e1c \u0111\u1ebfn 98%). T\u01b0\u01a1ng t\u1ef1 v\u1edbi FENa, FEUrea c\u0169ng kh\u00f4ng n\u00ean d\u00f9ng ri\u00eang bi\u1ec7t m\u00e0 n\u00ean k\u1ebft h\u1ee3p chung v\u1edbi b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng nh\u1ea5t \u0111\u1ecbnh tr\u01b0\u1edbc khi ch\u1ea9n \u0111o\u00e1n.<\/p>\n
Soi n\u01b0\u1edbc ti\u1ec3u<\/h3>\n
B\u00e1c s\u0129 n\u00ean ki\u1ec3m tra c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u v\u00ec b\u1ea5t th\u01b0\u1eddng trong x\u00e9t nghi\u1ec7m c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb g\u1ee3i \u00fd qu\u00e1 tr\u00ecnh trong th\u1eadn. Tr\u1ee5 h\u1ea1t \u201cb\u00f9n\u201d v\u00e0 t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 \u1ed1ng th\u1eadn (RTEC) th\u01b0\u1eddng t\u00ecm th\u1ea5y trong ATN. Tr\u1ee5 h\u1ed3ng c\u1ea7u v\u00e0 t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u bi\u1ebfn d\u1ea1ng g\u1ee3i \u00fd nguy\u00ean nh\u00e2n ch\u00ednh n\u1eb1m \u1edf c\u1ea7u th\u1eadn, v\u00e0 tr\u1ee5 b\u1ea1ch c\u1ea7u th\u01b0\u1eddng t\u00ecm th\u1ea5y khi c\u00f3 vi\u00eam nhi\u1ec5m trong khoang k\u1ebd nh\u01b0 trong vi\u00eam th\u1eadn k\u1ebd c\u1ea5p t\u00ednh (AIN) v\u00e0 vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn (pyelonephritis). C\u1ea7n l\u01b0u \u00fd tr\u1ee5 h\u1ed3ng c\u1ea7u v\u00e0 tr\u1ee5 b\u1ea1ch c\u1ea7u r\u1ea5t m\u1ecfng v\u00e0 n\u1ebfu ch\u00fang v\u1eafng m\u1eb7t th\u00ec kh\u00f4ng c\u1ea7n thi\u1ebft lo\u1ea1i b\u1ecf c\u00e1c r\u1ed1i lo\u1ea1n li\u00ean quan c\u1ee7a ch\u00fang kh\u1ecfi ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t.<\/p>\n
C\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u trung b\u00ecnh v\u00e0 tr\u1ee5 trong su\u1ed1t g\u1ee3i \u00fd AKI tr\u01b0\u1edbc th\u1eadn. V\u00ec ng\u01b0\u1eddi ta tin l\u00e0 AKI tr\u01b0\u1edbc th\u1eadn v\u00e0 ATN l\u00e0 m\u1ed9t ph\u1ed5 c\u00f3 th\u1ec3 c\u00f9ng t\u1ed3n t\u1ea1i, r\u1ea5t h\u1eefu \u00edch \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u1ecbnh l\u01b0\u1ee3ng c\u00e1c k\u1ebft qu\u1ea3 trong n\u01b0\u1edbc ti\u1ec3u (s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o ho\u1eb7c tr\u1ee5 tr\u00ean m\u1ed7i tr\u01b0\u1eddng khu\u1ebfch \u0111\u1ea1i k\u00ednh hi\u1ec3n vi th\u1ea5p hay cao). C\u00e1c h\u1ec7 th\u1ed1ng t\u00ednh \u0111i\u1ec3m kh\u00e1c nhau \u0111\u01b0\u1ee3c th\u00e0nh l\u1eadp cho th\u1ea5y m\u1ed1i t\u01b0\u01a1ng quan gi\u1eefa t\u0103ng s\u1ed1 l\u01b0\u1ee3ng RTEC ho\u1eb7c tr\u1ee5 h\u1ea1t v\u1edbi th\u1eadn k\u00e9m ph\u1ee5c h\u1ed3i. Khuy\u1ebfn kh\u00edch h\u1ed9i ch\u1ea9n c\u00e1c b\u00e1c s\u0129 \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o xem k\u1ebft qu\u1ea3 soi c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n v\u00e0 ti\u00ean l\u01b0\u1ee3ng cao tr\u00ean b\u1ec7nh nh\u00e2n n\u1eb7ng.<\/p>\n
C\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc n\u01b0\u1edbc ti\u1ec3u<\/h3>\n
Nhi\u1ec1u d\u1ea5u \u1ea5n sinh h\u1ecdc n\u01b0\u1edbc ti\u1ec3u \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n AKI. C\u00e1c x\u00e9t nghi\u1ec7m n\u00e0y g\u1ed3m lipocalin li\u00ean quan gelatinase (NGAL), interleukin 18 (IL-18), ph\u00e2n t\u1eed 1 t\u1ed5n th\u01b0\u01a1ng th\u1eadn (KIM-1), ch\u1ea5t \u1ee9c ch\u1ebf m\u00f4 c\u1ee7a metalloprotease 2 (TIMP-2) v\u00e0 y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng gi\u1ed1ng insuline li\u00ean k\u1ebft protein 7 (IGFBP7). V\u00e0o n\u0103m 2014, \u1ee7y ban th\u1ef1c ph\u1ea9m v\u00e0 thu\u1ed1c (FDA) cho ph\u00e9p l\u01b0u h\u00e0nh th\u01b0\u01a1ng m\u1ea1i (TIMP-2)x(IGFBP7) d\u01b0\u1edbi t\u00ean g\u1ecdi
\nNephroCheck l\u00e0 d\u1ea5u \u1ea5n sinh h\u1ecdc \u0111\u1ea7u ti\u00ean v\u00e0 duy nh\u1ea5t \u0111\u1ec3 ph\u00e2n lo\u1ea1i nguy c\u01a1 AKI s\u1eed d\u1ee5ng t\u1ea1i Hoa K\u1ef3. \u01afu ti\u00ean d\u00f9ng trong 24h \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i n\u1eb1m \u1edf ICU c\u00f3 h\u01a1n 21 n\u0103m m\u1eafc b\u1ec7nh tim m\u1ea1ch v\u00e0\/ho\u1eb7c suy \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p. X\u00e9t nghi\u1ec7m d\u01b0\u01a1ng t\u00ednh (>0.3) c\u00f3 ngh\u0129a nguy c\u01a1 cao AKI trong 12h v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u01b0 v\u1ea5n v\u1ec1 b\u1ec7nh th\u1eadn v\u00e0 ti\u1ebfn h\u00e0nh chi\u1ebfn l\u01b0\u1ee3c d\u1ef1 ph\u00f2ng nh\u01b0 t\u1ed1i \u01b0u l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u v\u00e0 c\u00e1c thu\u1ed1c tr\u00e1nh g\u00e2y \u0111\u1ed9c th\u1eadn.<\/p>\n
B\u1ec7nh nguy\u00ean c\u1ee7a AKI<\/h2>\n
AKI Tr\u01b0\u1edbc th\u1eadn<\/h3>\n
B\u1ec7nh nguy\u00ean<\/em><\/p>\n
Trong b\u1ec7nh c\u1ea3nh tr\u01b0\u1edbc th\u1eadn, b\u1ea3o t\u1ed3n t\u00ednh to\u00e0n v\u1eb9n c\u1ee7a nhu m\u00f4 th\u1eadn. Gi\u1ea3m \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn l\u00e0 \u0111\u00e1p \u1ee9ng sinh l\u00fd v\u1edbi gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn do suy gi\u1ea3m th\u1ec3 t\u00edch th\u1eadt s\u1ef1 ho\u1eb7c \u201chi\u1ec7u qu\u1ea3\u201d. C\u00e1c v\u00ed d\u1ee5 gi\u1ea3m th\u1ec3 t\u00edch th\u1eadt s\u1ef1 do nhi\u1ec1u nguy\u00ean nh\u00e2n, gi\u1ea3m cung l\u01b0\u1ee3ng tim, suy gan, s\u1ed1c ph\u1ea3n v\u1ec7 v\u00e0 nhi\u1ec5m tr\u00f9ng huy\u1ebft.<\/p>\n
Co m\u1ea1ch th\u1eadn (nh\u01b0 t\u0103ng canxi m\u00e1u, nhi\u1ec5m tr\u00f9ng huy\u1ebft, suy gan, c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf calci ni\u1ec7u v\u00e0 norepinephrine) v\u00e0 suy gi\u1ea3m kh\u1ea3 n\u0103ng t\u1ef1 \u0111i\u1ec1u h\u00f2a c\u1ee7a th\u1eadn (nh\u01b0 NSAID, \u1ee9c ch\u1ebf enzym chuy\u1ec3n h\u00f3a angiotensin [ACEI] v\u00e0 ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin II [ARBs] v\u00e0 c\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p l\u00e0m t\u0103ng
\nt\u00edch t\u1ee5 c\u00e1c s\u1ea3n ph\u1ea9m nit\u01a1 trong m\u00e1u tr\u01b0\u1edbc th\u1eadn. Gi\u1ea3m t\u01b0\u1edbi m\u00e1u c\u0169ng c\u00f3 th\u1ec3 do duy tr\u00ec \u00e1p l\u1ef1c trong \u1ed5 b\u1ee5ng >20mmHg, d\u1eabn \u0111\u1ebfn h\u1ed9i ch\u1ee9ng khoang b\u1ee5ng. H\u1ed9i ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong xu\u1ea5t huy\u1ebft \u1ed5 b\u1ee5ng, c\u1ed5 tr\u01b0\u1edbng l\u1edbn, ch\u01b0\u1edbng b\u1ee5ng, ph\u1eabu thu\u1eadt \u1ed5 b\u1ee5ng v\u00e0 sau gh\u00e9p gan.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n<\/em><\/p>\n
Ch\u1ea9n \u0111o\u00e1n d\u1ef1a tr\u00ean b\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng. Trong AKI tr\u01b0\u1edbc th\u1eadn, c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u \u0111i\u1ec3n h\u00ecnh m\u1ecfng, thi\u1ebfu t\u1ebf b\u00e0o, d\u1ea1ng tinh th\u1ec3 v\u00e0 c\u00f3 tr\u1ee5 t\u1ebf b\u00e0o. C\u00e1c ch\u1ea5t h\u00f3a h\u1ecdc trong n\u01b0\u1edbc ti\u1ec3u ph\u1ea3n \u00e1nh \u0111\u00e1p \u1ee9ng c\u1ea7u th\u1eadn th\u00edch h\u1ee3p v\u1edbi gi\u1ea3m t\u01b0\u1edbi m\u00e1u, t\u00e1i h\u1ea5p thu natri. T\u00ednh ra FENa <1% v\u00e0 natri ni\u1ec7u th\u01b0\u1eddng < 10mmol\/l. C\u00f4 \u0111\u1eb7c n\u01b0\u1edbc ti\u1ec3u r\u00f5 r\u1ec7t v\u00e0 \u0111\u1ed9 th\u1ea9m th\u1ea5u n\u01b0\u1edbc ti\u1ec3u th\u01b0\u1eddng >500 mOsm\/kg. FENa v\u00e0 FEUrea \u0111\u01b0\u1ee3c d\u00f9ng nhi\u1ec1u nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n thi\u1ec3u ni\u1ec7u nh\u01b0 \u0111\u00e3 th\u1ea3o lu\u1eadn ph\u00eda tr\u00ean.<\/p>\n
\u0110i\u1ec1u tr\u1ecb<\/em><\/p>\n
Nhanh ch\u00f3ng lo\u1ea1i b\u1ecf nguy\u00ean nh\u00e2n g\u00e2y gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn l\u00e0 r\u1ea5t quan tr\u1ecdng v\u00ec h\u1eadu qu\u1ea3 c\u1ee7a th\u1eadn thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 k\u00e9o d\u00e0i l\u00e0 t\u1ed5n th\u01b0\u01a1ng \u1ed1ng th\u1eadn (s\u01a1 \u0111\u1ed3 43.2). T\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c\/t\u00e1c nh\u00e2n g\u00e2y t\u1ed5n h\u1ea1i n\u00ean d\u1eebng ngay l\u1eadp t\u1ee9c. Trong tr\u01b0\u1eddng h\u1ee3p gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n, t\u00f9y thu\u1ed9c v\u00e0o ngu\u1ed3n d\u1ecbch m\u1ea5t, b\u1ed3i ho\u00e0n th\u1ec3 t\u00edch b\u1eb1ng n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd b\u00ecnh th\u01b0\u1eddng ho\u1eb7c c\u00e1c ch\u1ebf ph\u1ea9m m\u00e1u n\u00ean l\u00e0m ngay kh\u00f4ng \u0111\u01b0\u1ee3c tr\u00ec ho\u00e3n. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p d\u01b0 th\u1eeba th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n, nh\u01b0 suy tim sung huy\u1ebft ho\u1eb7c s\u1ed1c tim, \u0111i\u1ec1u tr\u1ecb theo h\u01b0\u1edbng t\u1ed1i \u0111a h\u00f3a ch\u1ee9c n\u0103ng tim, \u0111\u1eb7c bi\u1ec7t b\u1eb1ng l\u1ee3i ti\u1ec3u, thu\u1ed1c t\u0103ng co b\u00f3p c\u01a1 tim t\u00edch c\u1ef1c, gi\u1ea3m h\u1eadu t\u1ea3i v\u00e0 c\u00e1c thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n c\u01a1 h\u1ecdc. Theo d\u00f5i huy\u1ebft \u0111\u1ed9ng x\u00e2m l\u1ea5n c\u00f3 th\u1ec3 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb khi kh\u00f3 x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch ch\u1ec9 b\u1eb1ng \u0111\u00e1nh gi\u00e1 kh\u00f4ng x\u00e2m l\u1ea5n.<\/p>\n
$\"S\u01a0$
S\u01a0 \u0110\u1ed2 43.2: \u0110i\u1ec1u tr\u1ecb c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p tr\u01b0\u1edbc th\u1eadn<\/figcaption><\/figure>\n
\u0110i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng gan th\u1eadn (HRS) v\u1eabn c\u00f2n nhi\u1ec1u th\u00e1ch th\u1ee9c tr\u00ean l\u00e2m s\u00e0ng. HRS l\u00e0 bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0ng c\u00f3 kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c c\u1ee7a b\u1ec7nh gan giai \u0111o\u1ea1n cu\u1ed1i c\u0169ng nh\u01b0 suy gan t\u1ed1i c\u1ea5p do b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n n\u00e0o (nh\u01b0 u th\u00e2m nhi\u1ec5m ho\u1eb7c ng\u1ed9 \u0111\u1ed9c acetaminophen). H\u1eadu qu\u1ea3 l\u00e0 co m\u1ea1ch trong th\u1eadn n\u1eb7ng trong b\u1ec7nh c\u1ea3nh gi\u00e3n m\u1ea1ch v\u00e0 gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n hi\u1ec7u qu\u1ea3. HRS c\u00f3 th\u1ec3 x\u1ea3y ra t\u1ef1 ph\u00e1t trong b\u1ec7nh gan n\u1eb7ng ho\u1eb7c di\u1ec5n ti\u1ebfn sau m\u1ed9t bi\u1ebfn c\u1ed1 th\u00fac \u0111\u1ea9y nh\u01b0 nhi\u1ec5m tr\u00f9ng (nh\u01b0 vi\u00eam ph\u00fac m\u1ea1c nhi\u1ec5m khu\u1ea9n nguy\u00ean ph\u00e1t), xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a ho\u1eb7c ch\u1ecdc d\u1ecbch b\u00e1ng b\u1ee5ng l\u01b0\u1ee3ng l\u1edbn m\u00e0 kh\u00f4ng truy\u1ec1n albumin. Tr\u00ean b\u1ec7nh nh\u00e2n vi\u00eam ph\u00fac m\u1ea1c nhi\u1ec5m khu\u1ea9n nguy\u00ean ph\u00e1t, truy\u1ec1n albumin c\u00f3 th\u1ec3 d\u1ef1 ph\u00f2ng HRS.<\/p>\n\n\n\n\n
B\u1ea2NG 43.2<\/td>\n Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng gan th\u1eadn<\/td>\n<\/tr>\n
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X\u01a1 gan c\u1ed5 tr\u01b0\u1edbng<\/li>\n
Suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn nghi\u00eam tr\u1ecdng t\u1eeb nhi\u1ec1u ng\u00e0y \u0111\u1ebfn v\u00e0i tu\u1ea7n c\u00f3 creatinin huy\u1ebft thanh \u00edt nh\u1ea5t 1.5 mg\/dL<\/li>\n
Kh\u00f4ng c\u00f3 b\u1ec7nh t\u1ea1i th\u1eadn bi\u1ec3u hi\u1ec7n b\u1eb1ng protein ni\u1ec7u (>500mg\/ng\u00e0y), ti\u1ec3u m\u00e1u vi th\u1ec3 (>50 t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u tr\u00ean quang tr\u01b0\u1eddng cao), v\u00e0\/ho\u1eb7c c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 c\u1ea5u tr\u00fac t\u00ecm th\u1ea5y tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc.<\/li>\n
Kh\u00f4ng s\u1ed1c<\/li>\n
Kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi ho\u1eb7c g\u1ea7n \u0111\u00e2y s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c g\u00e2y \u0111\u1ed9c th\u1eadn<\/li>\n
Kh\u00f4ng c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng th\u1eadn sau khi ng\u1eebng l\u1ee3i ti\u1ec3u v\u00e0 t\u0103ng albumin \u00edt nh\u1ea5t 2 ng\u00e0y. Li\u1ec1u d\u00f9ng Albumin 1g\/kg c\u00e2n n\u1eb7ng\/ng\u00e0y \u0111\u1ebfn t\u1ed1i \u0111a 100g\/ng\u00e0y<\/li>\n<\/ul>\n
PH\u00c2N LO\u1ea0I<\/p>\n
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Lo\u1ea1i 1: Di\u1ec5n ti\u1ebfn nhanh, t\u0103ng g\u1ea5p \u0111\u00f4i creatinin huy\u1ebft thanh > 2.5 mg\/dl trong < 2 tu\u1ea7n<\/li>\n
Lo\u1ea1i 2: Suy th\u1eadn trung b\u00ecnh, v\u1edbi m\u1ed9t \u0111\u1ee3t di\u1ec5n ti\u1ebfn ch\u1eadm. Creatinin huy\u1ebft thanh 1.5-2.5mg\/dl. Th\u01b0\u1eddng li\u00ean quan c\u1ed5 tr\u01b0\u1edbng k\u00e9o d\u00e0i.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Diagnostic criteria of hepatorenal syndrome are adapted from Salerno F, Gerbes A, Gin\u00e8s P, et al. Diagnosis, prevention, and treatment of hepatorenal syndrome in cirrhosis.<\/p>\n
HRS l\u00e0 ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb (xem b\u1ea3ng 43.2 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n HRS). Ti\u00ean l\u01b0\u1ee3ng HRS r\u1ea5t ngh\u00e8o n\u00e0n (lo\u1ea1i 1 n\u1eb7ng h\u01a1n lo\u1ea1i 2) c\u0169ng nh\u01b0 c\u00f3 r\u1ea5t \u00edt chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb HRS v\u00e0 gh\u00e9p gan l\u00e0 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb d\u1ee9t \u0111i\u1ec3m duy nh\u1ea5t (b\u1ea3ng 43.3). HRS c\u00f3 th\u1ec3 gi\u1ea3m khi c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng gan trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng gan c\u1ea5p v\u00e0 vi\u00eam gan do r\u01b0\u1ee3u. \u0110i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn n\u00ean ch\u1ee7 y\u1ebfu d\u00e0nh cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u00ean l\u01b0\u1ee3ng h\u1ed3i ph\u1ee5c ch\u1ee9c n\u0103ng gan ho\u1eb7c nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn gh\u00e9p gan.<\/p>\n
AKI sau th\u1eadn<\/h3>\n
AKI sau th\u1eadn xu\u1ea5t hi\u1ec7n khi \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn gi\u1ea3m th\u1ee9 ph\u00e1t do c\u1ea3n tr\u1edf b\u00e0i xu\u1ea5t l\u01b0u l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u v\u00ec nh\u1eefng thay \u0111\u1ed5i c\u1ea5u tr\u00fac ho\u1eb7c ch\u1ee9c n\u0103ng tr\u00ean \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u. \u0110\u00e2y l\u00e0 nguy\u00ean nh\u00e2n r\u1ea5t hi\u1ebfm g\u1eb7p c\u1ee7a AKI trong ICU. T\u0103ng \u00e1p l\u1ef1c \u0111\u01b0\u1eddng ti\u1ec3u \u0111\u01b0\u1ee3c truy\u1ec1n \u1edf \u0111o\u1ea1n g\u1ea7n ch\u1ed7 t\u1eafc ngh\u1ebdn, h\u1eadu qu\u1ea3 l\u00e0m t\u0103ng \u00e1p l\u1ef1c trong \u1ed1ng th\u1eadn v\u00e0 cu\u1ed1i c\u00f9ng gi\u1ea3m gradient \u00e1p su\u1ea5t th\u1ee7y t\u0129nh \u0111i qua mao m\u1ea1ch c\u1ea7u th\u1eadn, d\u1eabn \u0111\u1ebfn gi\u1ea3m \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn c\u0169ng nh\u01b0
\nthay \u0111\u1ed5i ch\u1ee9c n\u0103ng \u1ed1ng th\u1eadn (gi\u1ea3m kh\u1ea3 n\u0103ng c\u00f4 \u0111\u1eb7c, nhi\u1ec5m toan \u1ed1ng l\u01b0\u1ee3n xa).<\/p>\n
T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ti\u1ec3u c\u00f3 th\u1ec3 1 b\u00ean ho\u1eb7c 2 b\u00ean, c\u1ea5p t\u00ednh hay m\u1ea1n t\u00ednh, 1 ph\u1ea7n hay to\u00e0n b\u1ed9, trong th\u1eadn (t\u1eafc ngh\u1ebdn \u1ed1ng th\u1eadn do tinh th\u1ec3, tr\u1ee5) ho\u1eb7c ngo\u00e0i th\u1eadn. Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng tr\u00ean l\u00e2m s\u00e0ng thay \u0111\u1ed5i t\u00f9y v\u00e0o th\u1eddi gian, m\u1ee9c \u0111\u1ed9 v\u00e0 v\u1ecb tr\u00ed t\u1eafc. T\u1eafc 1 b\u00ean th\u01b0\u1eddng kh\u00f4ng g\u00e2y suy th\u1eadn. L\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u kh\u00f4ng th\u1ec3 ch\u1ea9n \u0111o\u00e1n, ngo\u1ea1i tr\u1eeb v\u00f4 ni\u1ec7u g\u1ee3i \u00fd t\u1eafc ngh\u1ebdn ho\u00e0n to\u00e0n.<\/p>\n\n\n\n\n
B\u1ea2NG 43.3 \u0110i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng gan th\u1eadn lo\u1ea1i 1\u00a0<\/span><\/td>\n<\/tr>\n
C\u00e1c ch\u1ea5t co m\u1ea1ch v\u00e0 albumin<\/p>\n
Terlipressin: kh\u00f4ng c\u00f3 \u1edf Hoa K\u1ef3<\/p>\n
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Midodrine (co m\u1ea1ch h\u1ec7 th\u1ed1ng) + octreotide (\u1ee9c ch\u1ebf ph\u00f3ng th\u00edch ch\u1ea5t co m\u1ea1ch n\u1ed9i sinh) Midodrine 5\u201315 mg u\u1ed1ng 3 l\u1ea7n\/ng\u00e0y<\/li>\n
Octreotide 100\u2013200 g ti\u00eam d\u01b0\u1edbi da 3 l\u1ea7n\/ng\u00e0y<\/li>\n
Norepinephrine: d\u1eef li\u1ec7u h\u1ea1n ch\u1ebf<\/li>\n<\/ul>\n
Th\u00f4ng c\u1eeda ch\u1ee7 trong gan qua t\u0129nh m\u1ea1ch c\u1ea3nh<\/p>\n
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\u0110i\u1ec1u tr\u1ecb c\u1ed5 tr\u01b0\u1edbng k\u00e9o d\u00e0i<\/li>\n
C\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n d\u1ea7n ch\u1ee9c n\u0103ng th\u1eadn D\u1eef li\u1ec7u r\u1ea5t h\u1ea1n ch\u1ebf<\/li>\n
Hi\u1ec7u qu\u1ea3 s\u1ed1ng c\u00f2n ch\u01b0a r\u00f5 r\u00e0ng<\/li>\n<\/ul>\n
Li\u1ec7u ph\u00e1p thay th\u1ebf th\u1eadn<\/p>\n
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C\u1ea7u n\u1ed1i gh\u00e9p gan HO\u1eb6C Ch\u1edd ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng gan<\/li>\n<\/ul>\n
Gh\u00e9p gan<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ch\u1ea9n \u0111o\u00e1n s\u01a1 b\u1ed9 d\u1ef1a v\u00e0o b\u1ec7nh s\u1eed, kh\u00e1m l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh th\u1eadn \u1ee9 n\u01b0\u1edbc tr\u00ean si\u00eau \u00e2m th\u1eadn v\u00e0 ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh CT. N\u1ebfu kh\u00f4ng c\u00f3 th\u1eadn \u1ee9 n\u01b0\u1edbc tr\u00ean h\u00ecnh \u1ea3nh Xquang c\u0169ng kh\u00f4ng ho\u00e0n to\u00e0n lo\u1ea1i tr\u1eeb t\u1eafc ngh\u1ebdn. Trong t\u00ecnh tr\u1ea1ng suy gi\u1ea3m th\u1ec3 t\u00edch n\u1eb7ng, x\u01a1 h\u00f3a sau ph\u00fac m\u1ea1c v\u00e0 giai \u0111o\u1ea1n t\u1eafc ngh\u1ebdn s\u1edbm, \u0111\u00e0i th\u1eadn c\u00f3 th\u1ec3 kh\u00f4ng gi\u00e3n v\u00e0 si\u00eau \u00e2m c\u00f3 th\u1ec3 \u00e2m t\u00ednh gi\u1ea3. M\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u01a1n gi\u1ea3n \u0111\u00e1nh gi\u00e1 t\u1eafc ngh\u1ebdn \u0111o\u1ea1n xa l\u00e0 \u0111o l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u t\u1ed3n l\u01b0u sau khi \u0111i ti\u1ec3u, n\u1ebfu >100ml th\u00ec nghi ng\u1edd t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra b\u00e0ng quang. T\u1eafc \u1ed1ng th\u00f4ng Forley do c\u1ee5c m\u00e1u \u0111\u00f4ng c\u0169ng n\u00ean c\u00e2n nh\u1eafc v\u00e0 lo\u1ea1i tr\u1eeb b\u1eb1ng c\u00e1ch x\u1ea3 \u1ed1ng th\u00f4ng ho\u1eb7c thay b\u1eb1ng 1 c\u00e1i m\u1edbi. Trong \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c, n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ec9 s\u1ed1 nghi ng\u1edd cao tr\u00ean h\u00ecnh \u1ea3nh l\u00e2m s\u00e0ng (nh\u01b0 ph\u1eabu thu\u1eadt \u1ed5 b\u1ee5ng g\u1ea7n \u0111\u00e2y, ti\u1ec1n s\u1eed u di c\u0103n v\u00e0 d\u00f9ng thu\u1ed1c kh\u00e1ng cholinergic), k\u1ebft qu\u1ea3 thu \u0111\u01b0\u1ee3c t\u1eeb si\u00eau \u00e2m r\u1ea5t th\u1ea5p.<\/p>\n
M\u1ed9t khi ch\u1ea9n \u0111o\u00e1n t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ti\u1ec3u\/b\u1ec7nh th\u1eadn do t\u1eafc ngh\u1ebdn, ph\u1ea3i nhanh ch\u00f3ng can thi\u1ec7p \u0111\u1ec3 gi\u1ea3m thi\u1ec3u suy th\u1eadn trong th\u1eddi gian d\u00e0i. L\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p can thi\u1ec7p t\u00f9y v\u00e0o v\u1ecb tr\u00ed v\u00e0 nguy\u00ean nh\u00e2n t\u1eafc ngh\u1ebdn. \u0110a ni\u1ec7u r\u00f5 r\u00e0ng sau t\u1eafc ngh\u1ebdn th\u01b0\u1eddng th\u1ea5y khi thuy\u00ean gi\u1ea3m t\u1eafc ngh\u1ebdn ho\u00e0n to\u00e0n. M\u1eb7c d\u00f9 \u0111\u00e2y \u0111\u01b0\u1ee3c xem l\u00e0 ph\u1ea3n \u1ee9ng ph\u00f9 h\u1ee3p tr\u00ean nhi\u1ec1u b\u1ec7nh nh\u00e2n, khi xu\u1ea5t hi\u1ec7n gi\u1ea3m th\u1ec3 t\u00edch v\u00e0 m\u1ea5t c\u00e2n b\u1eb1ng \u0111i\u1ec7n gi\u1ea3i c\u1ea7n theo d\u00f5i s\u00e1t v\u00e0 can thi\u1ec7p.<\/p>\n
AKI t\u1ea1i th\u1eadn<\/h3>\n
B\u1ec7nh l\u00fd t\u1ea1i th\u1eadn xu\u1ea5t hi\u1ec7n khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 th\u1eadn. Ph\u00e2n lo\u1ea1i s\u00e2u h\u01a1n t\u00f9y v\u00e0o v\u1ecb tr\u00ed li\u00ean quan: c\u1ea7u th\u1eadn, m\u1ea1ch m\u00e1u, \u1ed1ng th\u1eadn ho\u1eb7c m\u00f4 k\u1ebd. Th\u01b0\u1eddng c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t c\u00e1c b\u1ec7nh c\u1ea3nh n\u00e0y b\u1eb1ng c\u00e1ch ph\u00e2n t\u00edch c\u1ea9n th\u1eadn c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u nh\u01b0 \u0111\u1ec1 c\u1eadp ph\u00eda tr\u00ean. Trong \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t, ATN do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 \u0111\u1ed9c th\u1eadn chi\u1ebfm tr\u00ean 90% AKI t\u1ea1i th\u1eadn.<\/p>\n
Ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p<\/h3>\n
B\u1ec7nh nguy\u00ean<\/em><\/p>\n
ATN c\u00f3 th\u1ec3 do b\u1ec7nh c\u1ea3nh tr\u01b0\u1edbc th\u1eadn k\u00e9o d\u00e0i (nh\u01b0 gi\u1ea3m th\u1ec3 t\u00edch v\u00e0 h\u1ea1 huy\u1ebft \u00e1p) ho\u1eb7c ng\u1ed9 \u0111\u1ed9c (nh\u01b0 thu\u1ed1c c\u1ea3n quang \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, kh\u00e1ng sinh aminoglycoside, kh\u00e1ng virus v\u00e0 kh\u00e1ng n\u1ea5m, myoglobin). Trong \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c, t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng \u0111\u1ed3ng th\u1eddi ho\u1eb7c li\u00ean ti\u1ebfp v\u00e0 kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y \u0111\u01a1n \u0111\u1ed9c (b\u1ea3ng 43.4 cung c\u1ea5p danh s\u00e1ch c\u00e1c nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn c\u1ee7a ATN). Tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n n\u1eb7ng, gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a ho\u1ea1i t\u1eed v\u1ecf th\u1eadn 2 b\u00ean, khi t\u00ecnh tr\u1ea1ng n\u00e0y k\u00e9o d\u00e0i c\u1ea7n ph\u1ea3i thay th\u1ebf th\u1eadn v\u00e0 \u0111\u00f4i khi t\u1ed5n th\u01b0\u01a1ng th\u1eadn kh\u00f4ng h\u1ed3i ph\u1ee5c.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n<\/em><\/p>\n
V\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng v\u00e0 k\u00e9o d\u00e0i, \u1ed1ng th\u1eadn s\u1ebd m\u1ea5t kh\u1ea3 n\u0103ng t\u00e1i h\u1ea5p thu natri v\u00e0 c\u00f4 \u0111\u1eb7c n\u01b0\u1edbc ti\u1ec3u. FENa th\u01b0\u1eddng >1% v\u00e0 FEUrea >50% v\u1edbi t\u1ef7 l\u1ec7 urea huy\u1ebft thanh m\u00e1u chia cho creatinin <20:1. \u0110\u00e1nh gi\u00e1 c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u s\u1ebd thu \u0111\u01b0\u1ee3c RTEC v\u00e0 tr\u1ee5 h\u1ea1t b\u00f9n n\u00e2u \u1edf h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n.V\u00ec c\u1ea7u th\u1eadn v\u00e0 khoang k\u1ebd th\u01b0\u1eddng nhi\u1ec1u, c\u00e1c h\u00ecnh \u1ea3nh trong n\u01b0\u1edbc ti\u1ec3u kh\u00e1c nh\u01b0 protein ni\u1ec7u v\u00e0 ti\u1ec1u m\u00e1u \u0111\u1ec1u kh\u00f4ng c\u00f3. M\u1eb7c d\u00f9 FENa r\u1ea5t h\u1eefu \u00edch ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t c\u00e1c nguy\u00ean nh\u00e2n tr\u01b0\u1edbc th\u1eadn v\u00e0 ATN, c\u00f3 m\u1ed9t v\u00e0i ngo\u1ea1i l\u1ec7. M\u1ed9t s\u1ed1 b\u1ec7nh c\u1ea3nh nh\u1ea5t \u0111\u1ecbnh d\u1eabn \u0111\u1ebfn ATN c\u00f3 th\u1ec3 l\u00e0m FENa gi\u1ea3m. B\u1ec7nh th\u1eadn do thu\u1ed1c c\u1ea3n quang (CIN) th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n l\u00e0 AKI kh\u00f4ng thi\u1ec3u ni\u1ec7u xu\u1ea5t hi\u1ec7n t\u1eeb 3-5 ng\u00e0y sau khi ti\u1ebfp x\u00fac ch\u1ea5t ch\u1ea5t ph\u00f3ng x\u1ea1. T\u1ed5n th\u01b0\u01a1ng th\u1eadn giai \u0111o\u1ea1n \u0111\u1ea7u, FENa th\u1ea5p (<1%) b\u1ea5t ch\u1ea5p kh\u00f4ng c\u00f3 gi\u1ea3m th\u1ec3 t\u00edch to\u00e0n th\u00e2n. \u0110\u00e2y l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a co m\u1ea1ch th\u1eadn k\u00e9o d\u00e0i do
\ngi\u1ea3i ph\u00f3ng endothelin khi ti\u00eam thu\u1ed1c c\u1ea3n quang. Ti\u00eau c\u01a1 v\u00e2n v\u00e0 t\u00e1n huy\u1ebft n\u1eb7ng gi\u1ea3i ph\u00f3ng c\u00e1c huy\u1ebft s\u1eafc t\u1ed1 (l\u1ea7n l\u01b0\u1ee3t myoglobin v\u00e0 hemoglobin) g\u00e2y \u0111\u1ed9c cho \u1ed1ng th\u1eadn, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong giai \u0111o\u1ea1n s\u1edbm v\u1edbi gi\u1ea3m FENa th\u1ee9 ph\u00e1t sau co m\u1ea1ch th\u1eadn.<\/p>\n
D\u1ef1 ph\u00f2ng<\/em><\/p>\n
Theo d\u00f5i ch\u1eb7t ch\u1ebd th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch v\u00e0 s\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng c\u00e1c thu\u1ed1c g\u00e2y \u0111\u1ed9c th\u1eadn c\u00f3 th\u1ec3 gi\u1ea3m \u0111\u1ec3 nguy c\u01a1 m\u1eafc AKI th\u1ee9 ph\u00e1t do ATN. Ph\u1ea7n l\u1edbn c\u00e1c k\u1ef9 thu\u1eadt d\u1ef1 ph\u00f2ng \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u trong l\u0129nh v\u1ef1c CIN. Nhi\u1ec1u d\u1ecbch truy\u1ec1n t\u0129nh m\u1ea1ch ch\u1ee9ng minh gi\u1ea3m nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng th\u1eadn \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e3 ti\u00eam thu\u1ed1c c\u1ea3n quang, nh\u01b0 n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd th\u00f4ng th\u01b0\u1eddng ho\u1eb7c truy\u1ec1n t\u0129nh m\u1ea1ch natri bicarbonate l\u00e0 hi\u1ec7u qu\u1ea3 nh\u1ea5t. Truy\u1ec1n dopamin \u201cli\u1ec1u cho th\u1eadn\u201d kh\u00f4ng ch\u1ee9ng minh l\u00e0 c\u00f3 l\u1ee3i d\u1ef1 ph\u00f2ng ho\u1eb7c gi\u00fap ph\u1ee5c h\u1ed3i ch\u1ee9c sau t\u1ed5n th\u01b0\u01a1ng th\u1eadn. Th\u1ef1c t\u1ebf, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u ch\u1ec9 ra l\u1ea1i l\u00e0m t\u0103ng nguy c\u01a1 AKI, v\u00e0 do \u0111\u00f3 kh\u00f4ng c\u00f3 vai tr\u00f2 d\u1ef1 ph\u00f2ng hay \u0111i\u1ec1u tr\u1ecb AKI. Ng\u01b0\u1eddi ta nghi\u00ean c\u1ee9u N-acetylcysteine trong nhi\u1ec1u th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u1ee1 m\u1eabu nh\u1ecf, k\u1ebft h\u1ee3p N-acetylcysteine v\u1edbi d\u1ecbch truy\u1ec3n t\u0129nh m\u1ea1ch c\u00f3 th\u1ec3 gi\u1ea3m nguy c\u01a1 m\u1eafc CIN. M\u1eb7c d\u00f9 hi\u1ec7u qu\u1ea3 n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u00f5 r\u00e0ng, N-acetylcysteine c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng tr\u00ean b\u1ec7nh nh\u00e2n nguy c\u01a1 cao m\u00e0 ph\u1ea3i ti\u00eam thu\u1ed1c c\u1ea3n quang, gi\u00e1
\nth\u00e0nh r\u1ebb, an to\u00e0n v\u00e0 c\u00f3 l\u1ee3i \u00edch ti\u1ec1m n\u0103ng. H\u1ec7 th\u1ed1ng gi\u00e1m s\u00e1t th\u1eadn (the real guard system) l\u00e0 m\u1ed9t thi\u1ebft b\u1ecb m\u1edbi ph\u00e1t minh nh\u1eb1m d\u1ef1 ph\u00f2ng CIN. Thi\u1ebft b\u1ecb n\u00e0y c\u1ea7n b\u1ec7nh nh\u00e2n d\u00f9ng l\u1ee3i ti\u1ec3u quai \u0111\u01b0\u1ee3c b\u00e1c s\u0129 k\u00ea \u0111\u01a1n \u0111\u1ec3 t\u1ea1o l\u01b0\u1ee3ng l\u1edbn n\u01b0\u1edbc ti\u1ec3u c\u1ea7n thi\u1ebft. H\u1ec7 th\u1ed1ng n\u00e0y \u0111o l\u01b0u l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u v\u00e0 thay th\u1ebf trong th\u1eddi gian th\u1ef1c b\u1eb1ng m\u1ed9t l\u01b0\u1ee3ng n\u01b0\u1edbc mu\u1ed1i v\u00f4 tr\u00f9ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng. Vi\u1ec7c n\u00e0y gi\u00fap v\u1eadn chuy\u1ec3n thu\u1ed1c c\u1ea3n quang qua th\u1eadn nhanh v\u00e0 \u00edt ti\u1ebfp ti\u1ebfp x\u00fac l\u01b0\u1ee3ng thu\u1ed1c c\u1ea3n quang h\u01a1n.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
B\u1ea2NG 43.4<\/td>\n C\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p g\u00e2y ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p<\/td>\n<\/tr>\n
Nguy\u00ean nh\u00e2n<\/td>\n \u0110\u1eb7c \u0111i\u1ec3m<\/td>\n<\/tr>\n
Thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9<\/td>\n H\u1eadu qu\u1ea3 c\u1ee7a c\u00e1c nguy\u00ean nh\u00e2n tr\u01b0\u1edbc th\u1eadn k\u00e9o d\u00e0i (gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n, s\u1ed1c nhi\u1ec5m tr\u00f9ng, s\u1ed1c tim)<\/p>\n
\u0110i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1ch gi\u1ea3i quy\u1ebft c\u00e1c nguy\u00ean nh\u00e2n n\u1ec1n v\u00e0 t\u01b0\u1edbi m\u00e1u th\u1eadn t\u1ed1i \u0111a<\/td>\n<\/tr>\n
Thu\u1ed1c c\u1ea3n quang ch\u1ee9a iode n\u1ed9i m\u1ea1ch<\/td>\n C\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 co m\u1ea1ch th\u1eadn v\u00e0 t\u1ed5n th\u01b0\u01a1ng \u1ed1ng th\u1eadn<\/p>\n
C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1: r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn c\u00f3 t\u1eeb tr\u01b0\u1edbc, suy tim, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy gi\u1ea3m th\u1ec3 t\u00edch, \u0111a u t\u1ee7y, th\u1ec3 tich thu\u1ed1c c\u1ea3n quang qu\u00e1 l\u1edbn v\u00e0 \u0111\u1ed9 t\u01b0\u01a1ng ph\u1ea3n th\u1ea9m th\u1ea5u cao.<\/p>\n
FENa <1%<\/p>\n
Hydrat h\u00f3a b\u1eb1ng natri clorua truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1eb7c natri bicarbonate cho th\u1ea5y l\u1ee3i \u00edch<\/p>\n
U\u1ed1ng N-acetylcysteine ho\u1eb7c truy\u1ec1n t\u0129nh m\u1ea1ch c\u00f3 th\u1ec3 gi\u00fap d\u1ef1 ph\u00f2ng<\/p>\n
H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n h\u1ed3i ph\u1ee5c ch\u1ee9c n\u0103ng th\u1eadn<\/td>\n<\/tr>\n
Ti\u00eau c\u01a1 v\u00e2n (Rhabdomyolysis)<\/td>\n C\u00f3 th\u1ec3 do ch\u1ea5n th\u01b0\u01a1ng d\u1eadp n\u00e1t, b\u1ea5t \u0111\u1ed9ng l\u00e2u ng\u00e0y, tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh, t\u0103ng th\u00e2n nhi\u1ec7t, thu\u1ed1c statin, d\u00f9ng cocain, h\u1ea1 phospho m\u00e1u, h\u1ea1 kali m\u00e1u, n\u1ecdc r\u1eafn ho\u1eb7c c\u00e1c r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a di truy\u1ec1n.<\/p>\n
M\u1ee9c \u0111\u1ed9 t\u0103ng enzym c\u01a1 kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng t\u01b0\u01a1ng quan v\u1edbi \u0111\u1ed9 n\u1eb7ng t\u1ed5n th\u01b0\u01a1ng th\u1eadn<\/p>\n
C\u00e1c c\u01a1 ch\u1ebf AKI: co m\u1ea1ch th\u1eadn, t\u1ed5n th\u01b0\u01a1ng \u1ed1ng l\u01b0\u1ee3n g\u1ea7n, t\u1eafc ngh\u1ebdn \u1ed1ng th\u1eadn do c\u00e1c tr\u1ee5 s\u1eafc t\u1ed1.<\/p>\n
T\u0103ng kali m\u00e1u. t\u0103ng phospho m\u00e1u, h\u1ea1 canxi m\u00e1u, t\u0103ng ure m\u00e1u<\/p>\n
Que nh\u00fang n\u01b0\u1edbc ti\u1ec3u c\u00f3 th\u1ec3 cho th\u1ea5y s\u1eafc t\u1ed1 heme khi kh\u00f4ng c\u00f3 h\u1ed3ng c\u1ea7u trong c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u<\/p>\n
N\u01b0\u1edbc ti\u1ec3u n\u1ed5i tr\u00ean b\u1ec1 m\u1eb7t c\u00f3 m\u00e0u t\u1eeb \u0111\u1ecf sang n\u00e2u<\/p>\n
FENa <1%<\/p>\n
\u0110i\u1ec1u tr\u1ecb d\u1ecbch t\u00edch c\u1ef1c (c\u00f3 th\u1ec3 truy\u1ec1n \u0111\u1ebfn 10 L n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd trong 24h) \u0111\u1ec3 \u0111\u1ed5 \u0111\u1ea7y th\u1ec3 t\u00edch v\u00e0 t\u0103ng t\u1ed1c \u0111\u1ed9 l\u01b0u th\u00f4ng n\u01b0\u1edbc ti\u1ec3u<\/td>\n<\/tr>\n
Ti\u1ec3u hemoglobin<\/td>\n Do t\u00e1n huy\u1ebft n\u1ed9i m\u1ea1ch<\/p>\n
Que nh\u00fang n\u01b0\u1edbc ti\u1ec3u c\u00f3 th\u1ec3 cho th\u1ea5y s\u1eafc t\u1ed1 heme khi kh\u00f4ng c\u00f3 h\u1ed3ng c\u1ea7u trong c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u<\/p>\n
FENa <1%<\/p>\n
T\u0103ng Lactate dehydrogenase, gi\u1ea3m haptoglobin v\u00e0 t\u0103ng bilirubin kh\u00f4ng li\u00ean h\u1ee3p<\/p>\n
\u0110i\u1ec1u tr\u1ecb t\u01b0\u01a1ng t\u1ef1 ti\u00eau c\u01a1 v\u00e2n v\u00e0 t\u1eadp trung gi\u1ea3i quy\u1ebft c\u00e1c nguy\u00ean nh\u00e2n n\u1ec1n<\/td>\n<\/tr>\n
Tr\u1ee5 trong b\u1ec7nh th\u1eadn<\/td>\n Tr\u1ee5 \u0111\u01b0\u1ee3c t\u1ea1o th\u00e0nh t\u1eeb chu\u1ed7i nh\u1eb9 (u t\u1ee7y) v\u00e0 protein Tamm-horsfall c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp \u1ed1ng th\u1eadn v\u00e0 t\u1eafc ngh\u1ebdn trong th\u1eadn.<\/p>\n
C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1: gi\u1ea3m th\u1ec3 t\u00edch, l\u1ee3i ti\u1ec3u quai, t\u0103ng canxi m\u00e1u, thu\u1ed1c c\u1ea3n quang IV
\nVai tr\u00f2 c\u1ee7a plasmapheres kh\u00f4ng r\u00f5 r\u00e0ng<\/td>\n<\/tr>\n
Aminoglycosides<\/td>\n Th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n 5-7 ng\u00e0y sau khi b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c<\/p>\n
\u0110i\u1ec1u tr\u1ecb c\u00e0ng k\u00e9o d\u00e0i c\u00e0ng l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 nhi\u1ec5m \u0111\u1ed9c th\u1eadn<\/p>\n
FENa >1% h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p<\/p>\n
Th\u01b0\u1eddng kh\u00f4ng thi\u1ec3u ni\u1ec7u<\/p>\n
M\u1ea5t \u0111\u00e1ng k\u1ec3 qua \u0111\u01b0\u1eddng ti\u1ec3u c\u00e1c ch\u1ea5t magie, kali v\u00e0 canxi<\/p>\n
Ph\u1ea3i m\u1ea5t nhi\u1ec1u tu\u1ea7n m\u1edbi h\u1ed3i ph\u1ee5c, ngay c\u1ea3 khi d\u1eebng thu\u1ed1c ngay l\u1eadp t\u1ee9c<\/td>\n<\/tr>\n
Amphotericin B<\/td>\n Hi\u1ec7u qu\u1ea3 t\u00edch l\u0169y<\/p>\n
G\u00e2y co m\u1ea1ch th\u1eadn d\u1eef d\u1ed9i c\u0169ng nh\u01b0 tr\u1ef1c ti\u1ebfp g\u00e2y \u0111\u1ed9c \u1ed1ng th\u1eadn b\u1eb1ng c\u00e1ch ph\u00e1 v\u1ee1 m\u00e0ng t\u1ebf b\u00e0o<\/p>\n
C\u00e1c ch\u1ebf ph\u1ea9m liposomal c\u00f3 \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn th\u1ea5p h\u01a1n<\/td>\n<\/tr>\n
acyclovir ti\u00eam t\u0129nh m\u1ea1ch<\/td>\n C\u00e1c ch\u1ea5t kh\u00f4ng h\u00f2a tan trong \u1ed1ng th\u1eadn l\u00e0m t\u1eafc ngh\u1ebdn<\/p>\n
C\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y tinh th\u1ec3 h\u00ecnh kim tr\u00ean c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u<\/p>\n
Ng\u01b0ng d\u00f9ng thu\u1ed1c th\u01b0\u1eddng h\u1ed3i ph\u1ee5c l\u1ea1i ch\u1ee9c n\u0103ng th\u1eadn<\/td>\n<\/tr>\n
Cisplatin<\/td>\n Li\u00ean quan \u0111\u1ebfn li\u1ec1u v\u00e0 Hi\u1ec7u qu\u1ea3 t\u00edch l\u0169y<\/p>\n
M\u1ea5t magie trong th\u1eadn k\u00e9o d\u00e0i, h\u1ea1 kali m\u00e1u<\/p>\n
N\u00ean truy\u1ec1n d\u1ecbch t\u00edch c\u1ef1c tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c \u0111\u1ec3 t\u0103ng n\u01b0\u1edbc ti\u1ec3u<\/td>\n<\/tr>\n
Ethylene glycol\/methanol<\/td>\n \u0110\u1ed9c t\u00ednh c\u00f3 th\u1ec3 do u\u1ed1ng r\u01b0\u1ee3u ch\u01b0ng g\u1ed7 (methanol) ho\u1eb7c ch\u1ea5t l\u1ecfng t\u1ea3n nhi\u1ec7t ch\u1ed1ng \u0111\u00f4ng (ethylene glycol)<\/p>\n
T\u0103ng kho\u1ea3ng tr\u1ed1ng osmol<\/p>\n
Toan chuy\u1ec3n h\u00f3a kho\u1ea3ng tr\u1ed1ng anion xu\u1ea5t hi\u1ec7n mu\u1ed9n h\u01a1n<\/p>\n
Tinh th\u1ec3 Oxalate (h\u00ecnh bao th\u01b0) hi\u1ec7n di\u1ec7n trong c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u v\u1edbi ethylene glycol nh\u01b0ng kh\u00f4ng c\u00f3 trong t\u00ecnh tr\u1ea1ng nhi\u1ec5m \u0111\u1ed9c methanol<\/p>\n
Thu\u1ed1c gi\u1ea3i \u0111\u1ed9c Fomepizole v\u1edbi li\u1ec1u n\u1ea1p 15mg\/kg h\u01a1n 30 ph\u00fat, sau \u0111\u00f3 15mg\/kg m\u1ed7i 12h<\/p>\n
L\u1ecdc m\u00e1u c\u00f3 th\u1ec3 l\u00e0m n\u1ebfu toan chuy\u1ec3n h\u00f3a kh\u00e1ng tr\u1ecb\/AK<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng ly gi\u1ea3i u<\/td>\n H\u1eadu qu\u1ea3 do l\u01b0\u1ee3ng l\u1edbn t\u1ebf b\u00e0o t\u00e2n sinh b\u1ecb gi\u1ebft nhanh ch\u00f3ng sau khi \u0111i\u1ec1u tr\u1ecb ung th\u01b0 ho\u1eb7c u t\u1ef1 ly gi\u1ea3i<\/p>\n
C\u00e1c ch\u1ea5t n\u1ed9i b\u00e0o \u0111\u01b0\u1ee3c ph\u00f3ng th\u00edch v\u00e0o tu\u1ea7n ho\u00e0n nh\u01b0 kali, phospho v\u00e0 acid uric<\/p>\n
<\/p>\n
H\u1ea7u h\u1ebft xu\u1ea5t hi\u1ec7n trong 48-72h sau \u0111i\u1ec1u tr\u1ecb ung th\u01b0<\/p>\n
T\u1ed5n th\u01b0\u01a1ng th\u1eadn l\u00e0 do t\u00edch t\u1ee5 acid uric trong m\u00f4i tr\u01b0\u1eddng acid c\u1ee7a \u1ed1ng th\u1eadn<\/p>\n
T\u0103ng phosho m\u00e1u c\u00f3 th\u1ec3 t\u1ea1o th\u00e0nh tinh th\u1ec3 canxi-phospho v\u00e0 v\u00f4i h\u00f3a th\u1eadn<\/p>\n
B\u1ec7nh nh\u00e2n th\u01b0\u1eddng thi\u1ec3u ni\u1ec7u, c\u00f3 th\u1ec3 c\u1ea7n l\u1ecdc m\u00e1u t\u1ea1m th\u1eddi m\u1eb7c d\u00f9 s\u1ebd h\u1ed3i ph\u1ee5c n\u1ebfu \u0111i\u1ec1u tr\u1ecb s\u1edbm<\/p>\n
\u0110i\u1ec1u tr\u1ecb b\u1eb1ng b\u00f9 d\u1ecbch t\u00edch c\u1ef1c, allopurinol v\u00e0 rasburicase<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\u0110i\u1ec1u tr\u1ecb v\u00e0 Ti\u00ean l\u01b0\u1ee3ng<\/em><\/p>\n
M\u1ed9t khi ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh ATN th\u00ec kh\u00f4ng c\u00f3 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u. Nh\u00ecn chung \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 v\u00e0 c\u1ea7n thi\u1ebft ph\u1ea3i thay th\u1ebf th\u1eadn. C\u1ea7n ph\u1ea3i c\u1ed1 g\u1eafng \u0111\u1ea3o ng\u01b0\u1ee3c t\u1ed5n th\u01b0\u01a1ng ban \u0111\u1ea7u. \u0110i\u1ec1u tr\u1ecb c\u0169ng n\u00ean t\u1eadp trung tr\u00e1nh c\u00e1c t\u1ed5n th\u01b0\u01a1ng g\u00e2y \u0111\u1ed9c th\u1eadn v\u00e0 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng thu\u1ed1c th\u00edch h\u1ee3p t\u00f9y m\u1ee9c \u0111\u1ed9 ch\u1ee9c n\u0103ng th\u1eadn. D\u1ef1a tr\u00ean nguy\u00ean nh\u00e2n v\u00e0 \u0111\u1ed9 n\u1eb7ng, c\u0169ng nh\u01b0 ch\u1ee9c n\u0103ng th\u1eadn n\u1ec1n, ph\u1ee5c h\u1ed3i th\u1eadn c\u1ea7n nhi\u1ec1u ng\u00e0y, v\u00e0i tu\u1ea7n hay th\u1eadm ch\u00ed nhi\u1ec1u th\u00e1ng. T\u00f3m l\u1ea1i, kho\u1ea3ng 75% b\u1ec7nh nh\u00e2n s\u1ebd ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng th\u1eadn n\u1ebfu tr\u01b0\u1edbc \u0111\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u00ecnh th\u01b0\u1eddng, mi\u1ec5n l\u00e0 h\u1ecd s\u1ed1ng s\u00f3t sau khi nh\u1eadp vi\u1ec7n.<\/p>\n
C\u00e1c qu\u00e1 tr\u00ecnh c\u1ea7u th\u1eadn v\u00e0 vi m\u1ea1ch m\u00e1u<\/h3>\n
C\u00e1c nguy\u00ean nh\u00e2n c\u1ea7u th\u1eadn g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1eadn \u00edt g\u1eb7p h\u01a1n trong b\u1ec7nh c\u1ea3nh c\u1ea5p t\u00ednh (b\u1ea3ng 43.5). Tuy nhi\u00ean, h\u1ed9i ch\u1ee9ng th\u1eadn ph\u1ed5i trong b\u1ec7nh GPA v\u00e0 Goodpasture n\u00ean c\u00e2n nh\u1eafc \u1edf b\u1ea5t k\u1ef3 b\u1ec7nh nh\u00e2n n\u00e0o r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u1ef1 ph\u00e1t ph\u1ed5i v\u00e0 th\u1eadn v\u00ec c\u1ea3 2 b\u1ec7nh \u0111\u1ec1u g\u00e2y t\u1eed vong n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c nh\u1eadn bi\u1ebft v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. Xu\u1ea5t hi\u1ec7n tr\u1ee5 h\u1ed3ng c\u1ea7u g\u1ee3i \u00fd nguy\u00ean nh\u00e2n ch\u00ednh t\u1ea1i c\u1ea7u th\u1eadn. Trong b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng th\u00edch h\u1ee3p, c\u00e1c ph\u00e1t hi\u1ec7n nh\u01b0 th\u1ebf s\u1ebd k\u00edch th\u00edch t\u00ecm nh\u1eefng r\u1ed1i lo\u1ea1n t\u1ea1i m\u1ea1ch m\u00e1u v\u00e0 c\u1ea7u th\u1eadn. X\u00e9t nghi\u1ec7m huy\u1ebft thanh h\u1ecdc r\u1ea5t h\u1eefu \u00edch trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, m\u1eb7c d\u00f9 sinh thi\u1ebft th\u1eadn sau c\u00f9ng gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh.<\/p>\n\n\n\n\n\n\n\n
B\u1ea2NG 43.5 C\u00e1c r\u1ed1i lo\u1ea1n c\u1ea7u th\u1eadn v\u00e0 vi m\u1ea1ch m\u00e1u ch\u1ecdn l\u1ecdc trong ICU<\/td>\n<\/tr>\n
Nguy\u00ean nh\u00e2n<\/td>\n \u0110\u1eb7c \u0111i\u1ec3m<\/td>\n \u0110i\u1ec1u tr\u1ecb<\/td>\n<\/tr>\n
Ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch<\/td>\n Gi\u1ea3m b\u1ed5 th\u1ec3 th\u01b0\u1eddng g\u1eb7p trong vi\u00eam c\u1ea7u th\u1eadn sau nhi\u1ec5m tr\u00f9ng
\nMFGN, SLE, Vi\u00eam m\u00e0ng ngo\u00e0i tim v\u00e0 cryoglobuline m\u00e1u.<\/td>\n \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n n\u1ec1n<\/td>\n<\/tr>\n
B\u1ec7nh mi\u1ec5n d\u1ecbch Pauci v\u00e0
\nkh\u00e1ng GBM<\/td>\n H\u1ed9i ch\u1ee9ng xu\u1ea5t huy\u1ebft ph\u1ed5i c\u00f3 th\u1ec3 l\u00e0n kh\u00e1ng th\u1ec3 c-ANCA,
\np-ANCA ho\u1eb7c kh\u00e1ng GBM huy\u1ebft thanh d\u01b0\u01a1ng t\u00ednh
\n(trong b\u1ec7nh Goodpasture)Bi\u1ebfn d\u1ea1ng h\u1ed3ng c\u1ea7u trong c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u g\u1ee3i \u00fd
\nnguy\u00ean nh\u00e2n ch\u00ednh t\u1ea1i c\u1ea7u th\u1eadn<\/td>\n \u0110i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i, th\u1edf m\u00e1y n\u1ebfu c\u1ea7n thi\u1ebft. Corticosteroid v\u00e0 c\u00e1c thu\u1ed1c g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o .<\/p>\n
Thay huy\u1ebft t\u01b0\u01a1ng \u0111\u1ed1i v\u1edbi b\u1ec7nh Goodpassture ho\u1eb7c vi\u00eam m\u1ea1ch c\u00f3 xu\u1ea5t huy\u1ebft ph\u1ed5i ho\u1eb7c suy th\u1eadn n\u1eb7ng.<\/td>\n<\/tr>\n
Vi m\u1ea1ch m\u00e1u<\/td>\n HUS v\u00e0 TTP l\u00e0m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u, thi\u1ebfu m\u00e1u t\u00e1n huy\u1ebft v\u00e0 m\u1ea3nh v\u1ee1 h\u1ed3ng c\u1ea7u khi ph\u1ebft m\u00e1u ngo\u1ea1i vi.<\/p>\n
B\u1ec7nh thuy\u00ean t\u1eafc x\u01a1 v\u1eefa
\nSuy th\u1eadn b\u00e1n c\u1ea5p, nhi\u1ec1u ng\u00e0y \u0111\u1ebfn v\u00e0i tu\u1ea7n sau th\u1ee7 thu\u1eadt can
\nthi\u1ec7pm\u1ea1ch m\u00e1u, bi\u1ec3u hi\u1ec7n m\u1ea1ng l\u01b0\u1edbi livedo v\u00e0 t\u0103ng eosinophil
\ntho\u00e1ng qua<\/td>\n
TTP c\u1ea7n ph\u1ea3i thay huy\u1ebft t\u01b0\u01a1ng kh\u1ea9n c\u1ea5p.<\/p>\n
Ch\u0103m s\u00f3c h\u1ed7 tr\u1ee3 v\u1edbi b\u1ec7nh HUS.<\/p>\n
TTP k\u00e9o d\u00e0i r\u1ea5t h\u1eefu hi\u1ec7u n\u1ebfu d\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch nh\u01b0 prednisone v\u00e0\/ho\u1eb7c rituximab v\u00e0 tr\u00e1nh d\u00f9ng c\u00e1c thu\u1ed1c kh\u00e1ng \u0111\u00f4ng v\u00e0 can thi\u1ec7p m\u1ea1ch m\u00e1u sau n\u00e0y.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
GN, vi\u00eam c\u1ea7u th\u1eadn; MPGN, vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng; SLE, lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, c-ANCA, kh\u00e1ng th\u1ec3 kh\u00e1ng b\u00e0o t\u01b0\u01a1ng c\u1ee7a b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh; p-ANCP, kh\u00e1ng th\u1ec3 kh\u00e1ng b\u00e0o t\u01b0\u01a1ng ngo\u00e0i nh\u00e2n b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh; GBM, m\u00e0ng \u0111\u00e1y c\u1ea7u th\u1eadn; RBSs, h\u1ed3ng c\u1ea7u; HUS, h\u1ed9i ch\u1ee9ng ure t\u00e1n huy\u1ebft; TTP, ban xu\u1ea5t huy\u1ebft ti\u1ec3u c\u1ea7u huy\u1ebft kh\u1ed1i.<\/p>\n
X\u00e9t nghi\u1ec7m kh\u00e1ng th\u1ec3 kh\u00e1ng m\u00e0ng \u0111\u00e1y c\u1ea7u th\u1eadn c\u00f3 \u0111\u1ed9 nh\u1ea1y cao (95%) v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao (99%) trong b\u1ec7nh Goodpasture. Trong GPA, kh\u00e1ng th\u1ec3 serin proteinase 3 (p-ANCA, kh\u00e1ng th\u1ec3 b\u00e0o t\u01b0\u01a1ng kh\u00e1ng nh\u00e2n b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh) t\u0103ng tr\u00ean 75% c\u00e1c tr\u01b0\u1eddng h\u1ee3p, kho\u1ea3ng 20% b\u1ec7nh nh\u00e2n t\u0103ng kh\u00e1ng th\u1ec3 myeloperoxidase
\n(p-ANCA) v\u00e0 <5% b\u1ec7nh nh\u00e2n c\u00f3 ANCA \u00e2m t\u00ednh. \u0110i\u1ec1u tr\u1ecb c\u00e1c h\u1ed9i ch\u1ee9ng n\u00e0y ph\u1ea3i ti\u00eam t\u0129nh m\u1ea1ch corticosteroide ngay l\u1eadp t\u1ee9c (methylprednisolone 7-15 mg\/kg\/ng\u00e0y, v\u00e0\/ho\u1eb7c t\u1ed1i \u0111a 1g\/ng\u00e0y trong 3 ng\u00e0y, ti\u1ebfp theo u\u1ed1ng prednisolone 1mg\/kg\/ng\u00e0y t\u1eeb 60-80mg) v\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o (u\u1ed1ng cyclophosphamide 2-3mg\/kg\/ng\u00e0y, ti\u00eam t\u0129nh m\u1ea1ch cyclophosphamide 15mg\/kg ho\u1eb7c 750 mg\/m2). \u0110i\u1ec1u tr\u1ecb thay th\u1ebf huy\u1ebft t\u01b0\u01a1ng c\u0169ng l\u00e0 h\u01b0\u1edbng \u0111ang ph\u00e1t tri\u1ec3n trong b\u1ec7nh Goodpasture. Trong vi\u00eam m\u1ea1ch c\u00f3 ANCA d\u01b0\u01a1ng t\u00ednh sau suy th\u1eadn n\u1eb7ng, 1 nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ee9ng minh y\u1ebfu t\u1ed1 d\u1ef1 \u0111o\u00e1n duy nh\u1ea5t li\u00ean quan l\u1ecdc m\u00e1u \u0111\u1ed9c l\u1eadp k\u00e9o d\u00e0i l\u00e0 s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p thay th\u1ebf huy\u1ebft t\u01b0\u01a1ng. Li\u1ec7u ph\u00e1p thay th\u1ebf huy\u1ebft t\u01b0\u01a1ng c\u0169ng khuy\u1ebfn c\u00e1o d\u00f9ng trong xu\u1ea5t huy\u1ebft ph\u1ed5i li\u00ean quan vi\u00eam m\u1ea1ch ANCA d\u01b0\u01a1ng t\u00ednh.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t h\u1ed9i ch\u1ee9ng ph\u1ed5i th\u1eadn bao g\u1ed3m vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng sau nhi\u1ec5m tr\u00f9ng huy\u1ebft v\u00e0 ATN, lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng c\u00f3 li\u00ean quan \u0111\u1ebfn ph\u1ed5i v\u00e0 vi\u00eam th\u1eadn lupus, sarcoidosis, nhi\u1ec5m tr\u00f9ng nh\u01b0 leptospirosis, legionella, ehrlichiosis (vi\u00eam ph\u1ed5i sau AIN ho\u1eb7c ATN), v\u00e0 vi\u00eam t\u1ee5y sau vi\u00eam ph\u1ed5i v\u00e0 ATN.<\/p>\n
H\u1ed9i ch\u1ee9ng ure t\u00e1n huy\u1ebft (HUS) v\u00e0 ban xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u huy\u1ebft kh\u1ed1i (TTP) l\u00e0 2 b\u1ec7nh l\u00fd vi m\u00f4 huy\u1ebft kh\u1ed1i ri\u00eang bi\u1ec7t c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1eadn. M\u1eb7c d\u00f9 c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ri\u00eang bi\u1ec7t, ch\u00fang \u0111\u1ec1u c\u00f3 chung c\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y nh\u01b0 nhi\u1ec5m HIV, b\u1ec7nh l\u00fd \u00e1c t\u00ednh, c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf calcineurin, mang thai v\u00e0 c\u00e1c thu\u1ed1c h\u00f3a
\ntr\u1ecb. Ticlopidine, v\u00e0 \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n l\u00e0 clopidogrel, c\u00f3 li\u00ean quan ch\u1eb7t ch\u1ebd nh\u1ea5t v\u1edbi TTP. Trong tri\u1ec7u ch\u1ee9ng ti\u00eau ch\u1ea3y c\u1ee7a HUS, ch\u1ea5t \u0111\u1ed9c gi\u1ed1ng Shiga \u0111i v\u00e0o tu\u1ea7n ho\u00e0n th\u00f4ng qua bi\u1ec3u m\u00f4 \u0111\u1ea1i tr\u00e0ng t\u1ed5n th\u01b0\u01a1ng v\u00e0 g\u00e2y vi\u00eam, t\u1ed5n th\u01b0\u01a1ng n\u1ed9i m\u00f4 v\u00e0 h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i trong vi m\u1ea1ch th\u1eadn. \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 HUS li\u00ean quan \u0111\u1ed9c t\u1ed1 c\u1ee7a
\nShiga, kh\u00e1ng sinh, kh\u00e1ng \u0111\u00f4ng v\u00e0 globulin mi\u1ec5n d\u1ecbch ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3. Tuy nhi\u00ean, trong HUS kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng nh\u00e2n t\u1ea1o \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng b\u1ed5 th\u1ec3 y\u1ebfu t\u1ed1 C5 (Eculizumab) \u0111\u00e3 ch\u1ee9ng minh \u0111\u01b0\u1ee3c l\u1ee3i \u00edch. Trong tr\u01b0\u1eddng h\u1ee3p TTP, thay th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng h\u00e0ng ng\u00e0y l\u00e0 bi\u1ec7n ph\u00e1p mang t\u00ednh
\ns\u1ed1ng c\u00f2n v\u00e0 do \u0111\u00f3 kh\u00f4ng \u0111\u01b0\u1ee3c tr\u00ec ho\u00e3n. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec1 kh\u00e1ng, c\u00f3 th\u1ec3 d\u00f9ng \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch b\u1eb1ng li\u1ec1u cao prednisone v\u00e0 rituximab. C\u1eaft l\u00e1ch \u0111\u00e3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00e1ng tr\u1ecb nh\u01b0ng l\u1ee3i \u00edch ch\u01b0a \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn.<\/p>\n
M\u1ed9t b\u1ec7nh c\u1ea3nh vi m\u1ea1ch m\u00e1u kh\u00e1c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn th\u1eadn l\u00e0 thuy\u00ean t\u1eafc x\u01a1 v\u1eefa. V\u00ec b\u1ec7nh nh\u00e2n n\u1eb1m vi\u1ec7n \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng xuy\u00ean c\u1ea7n c\u00e1c th\u1ee7 thu\u1eadt can thi\u1ec7p m\u1ea1ch m\u00e1u, n\u00ean nghi ng\u1edd cao \u0111\u1ed1i v\u1edbi thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i trong b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng ph\u00f9 h\u1ee3p. Nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y b\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn nhi\u1ec1u ng\u00e0y \u0111\u1ebfn nhi\u1ec1u tu\u1ea7n sau khi thao t\u00e1c tr\u00ean \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ho\u1eb7c c\u00e1c m\u1ea1ch m\u00e1u l\u1edbn kh\u00e1c, v\u00e0 di\u1ec5n ti\u1ebfn t\u1eeb t\u1eeb. T\u0103ng eosinophil ngo\u1ea1i vi tho\u00e1ng qua chi\u1ebfm tr\u00ean 65% c\u00e1c tr\u01b0\u1eddng h\u1ee3p. Gi\u1ea3m b\u1ed5 th\u1ec3 m\u00e1u c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a b\u1ec7nh. Nh\u1eefng d\u1ea5u hi\u1ec7u tr\u00ean da thay \u0111\u1ed5i nhi\u1ec1u v\u00e0 c\u00f3 th\u1ec3 g\u1ed3m m\u1ea1ng l\u01b0\u1edbi livedo tr\u00ean t\u1ee9 chi ho\u1eb7c ho\u1ea1i t\u1eed ng\u00f3n ch\u00e2n v\u1edbi ho\u1ea1i th\u01b0 (h\u1ed9i ch\u1ee9ng ng\u00f3n ch\u00e2n xanh). M\u1ea1ch \u0111\u1eadp ngo\u1ea1i bi\u00ean xu\u1ea5t hi\u1ec7n khi t\u1eafc t\u00f9y v\u00e0o m\u1ee9c \u0111\u1ed9 c\u00e1c \u0111\u1ed9ng m\u1ea1ch nh\u1ecf h\u01a1n ho\u1eb7c ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch. Nguy\u00ean t\u1eafc chung trong b\u1ec7nh th\u1eadn l\u00e0 gi\u1ea3m t\u1eeb t\u1eeb ch\u1ee9c n\u0103ng th\u1eadn trong nhi\u1ec1u th\u00e1ng, v\u1edbi 1\/3 b\u1ec7nh nh\u00e2n ph\u1ea3i l\u1ecdc m\u00e1u. Trong b\u1ec7nh huy\u1ebft kh\u1ed1i x\u01a1 v\u1eefa \u0111a t\u1ea1ng, bi\u1ec3u hi\u1ec7n b\u1eb1ng c\u00e1c b\u1ec7nh c\u1ea3nh nh\u01b0 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 ru\u1ed9t, vi\u00eam t\u1ee5y v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n kh\u00e1c, t\u1ef7 l\u1ec7 t\u1eed vong trong v\u00f2ng 1 n\u0103m c\u00f3 th\u1ec3 l\u00ean \u0111\u1ebfn 70%. Kh\u00f4ng c\u00f3 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3. N\u00ean tr\u00e1nh c\u00e1c th\u1ee7 thu\u1eadt can thi\u1ec7p m\u1ea1ch m\u00e1u v\u1ec1 sau m\u00e0 ph\u1ea3i ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p c\u00f3 suy x\u00e9t, s\u1eed d\u1ee5ng \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 b\u1ed5 sung dinh d\u01b0\u1ee1ng gi\u00fap ti\u00ean l\u01b0\u1ee3ng t\u1ed1t h\u01a1n. M\u1ed9t lo\u1ea1t c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 ghi nh\u1eadn l\u1ee3i \u00edch ti\u1ec1m n\u0103ng khi s\u1eed d\u1ee5ng statin \u0111\u1ec3 c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c th\u1eadn l\u00e2u d\u00e0i.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
B\u1ea2NG 43.6 C\u00e1c nguy\u00ean nh\u00e2n ch\u1ecdn l\u1ecdc c\u1ee7a Vi\u00eam \u1ed1ng k\u1ebd th\u1eadn c\u1ea5p t\u00ednh<\/td>\n<\/tr>\n
Thu\u1ed1c<\/td>\n Ch\u1ea9n \u0111o\u00e1n<\/td>\n Di\u1ec5n ti\u1ebfn<\/td>\n<\/tr>\n
Methicillin<\/td>\n Tri\u1ec7u ch\u1ee9ng qu\u00e1 m\u1eabn, n\u1ed5i tr\u1ed9i nh\u1ea5t l\u00e0 s\u1ed1t chi\u1ebfm 85%<\/p>\n
Ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u th\u01b0\u1eddng th\u1ea5y tr\u00ean 80% b\u1ec7nh nh\u00e2n ti\u1ec3u m\u00e1u, ti\u1ec3u m\u1ee7, t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan ho\u1eb7c proetin ni\u1ec7u kh\u00f4ng ph\u1ea3i h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/td>\n
H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n h\u1ed3i ph\u1ee5c l\u1ea1i ch\u1ee9c n\u0103ng th\u1eadn trong 2 th\u00e1ng, m\u1eb7c d\u00f9 1\/5 b\u1ec7nh nh\u00e2n ph\u1ea3i l\u1ecdc m\u00e1u t\u1ea1m th\u1eddi do CKD ch\u1ec9 c\u00f2n 10%<\/td>\n<\/tr>\n
Rifampin<\/td>\n Tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a (bu\u1ed3n n\u00f4n, n\u00f4n \u00f3i, \u0111au
\nb\u1ee5ng)Thi\u1ec3u ni\u1ec7u g\u1ea7n nh\u01b0 tr\u00ean t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n.Th\u01b0\u1eddng kh\u00f4ng t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan, m\u1eb7c d\u00f9 c\u00f3 th\u1ec3
\nxu\u1ea5t hi\u1ec7n nhi\u1ec1u b\u1ea5t th\u01b0\u1eddng trong m\u00e1u nh\u01b0 t\u00e1n huy\u1ebft
\n(25%) v\u00e0 gi\u1ea3m ti\u1ec3u c\u1ea7u (50%)
\n1\/4 b\u1ec7nh nh\u00e2n t\u0103ng men gan<\/p>\n
C\u00f3 kh\u00e1ng th\u1ec3 kh\u00e1ng rifampin trong h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n
\nHi\u1ebfm khi sinh thi\u1ebft th\u1eadn cho th\u1ea5y c\u00f3 ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch \u1edf
\nm\u00e0ng \u0111\u00e1y \u1ed1ng th\u1eadn,.<\/td>\n
X\u1ea3y ra trong 24h sau li\u1ec1u ph\u01a1i nhi\u1ec5m \u0111\u1ea7u ti\u00ean (t\u1ed1i \u0111a 1 n\u0103m tr\u01b0\u1edbc).<\/p>\n
C\u1ea7n l\u1ecdc m\u00e1u t\u1ea1m th\u1eddi \u1edf h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n c\u00f3 CKD ch\u1ec9 c\u00f2n 3%<\/td>\n<\/tr>\n
C\u00e1c kh\u00e1ng sinh kh\u00e1c
\n(sulfonamides, fluoroquinolones, beta-lactams)<\/td>\n \u00cdt g\u00e2y s\u1ed1t h\u01a1n methicilin (45%), nh\u01b0ng ph\u00e1t ban v\u00e0 \u0111au
\nm\u1ea1n s\u01b0\u1eddn trong h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n 50%, thi\u1ec3u ni\u1ec7u 40%<\/td>\n Th\u1eddi gian trung b\u00ecnh u\u1ed1ng kh\u00e1ng sinh l\u00e0 10 ng\u00e0y
\nCKD duy tr\u00ec kho\u1ea3ng 40%<\/td>\n<\/tr>\n
NSAIDs<\/td>\n C\u00e1c d\u1ea5u hi\u1ec7u trong n\u01b0\u1edbc ti\u1ec3u \u00edt g\u1eb7p h\u01a1n methiciline.<\/p>\n
H\u01a1n 1\/3 protein ni\u1ec7u do h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0. Sinh thi\u1ebft th\u1eadn c\u00f3 th\u1ec3 th\u1ea5y thay \u0111\u1ed5i t\u1ed1i thi\u1ec3u.<\/td>\n
D\u00f9ng kh\u00e1ng sinh tr\u01b0\u1edbc \u0111\u00f3 nhi\u1ec1u th\u00e1ng m\u1edbi bi\u1ec3u hi\u1ec7n tri\u1ec7u
\nch\u1ee9ng. CKD v\u1eabn c\u00f2n tr\u00ean 50% b\u1ec7nh nh\u00e2n.<\/td>\n<\/tr>\n
Allopurinol<\/td>\n C\u00e1c tri\u1ec7u ch\u1ee9ng qu\u00e1 m\u1eabn r\u1ea5t ph\u1ed5 bi\u1ebfn v\u00e0 r\u1ea7m r\u1ed9 v\u1edbi t\u00edch t\u1ee5 c\u00e1c oxypuriol trong qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a<\/td>\n T\u1ef7 l\u1ec7 t\u1eed vong c\u00f3 th\u1ec3 l\u00ean t\u1edbi 25%.<\/td>\n<\/tr>\n
\u1ee8c ch\u1ebf b\u01a1m proton<\/td>\n T\u0103ng eosinophil v\u00e0 vi\u00eam gan th\u01b0\u1eddng ph\u1ed5 bi\u1ebfn.<\/p>\n
Sinh thi\u1ebft th\u1eadn c\u00f3 th\u1ec3 th\u1ea5y ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch.<\/p>\n
\u1ea2nh h\u01b0\u1edfng theo t\u1eebng giai \u0111o\u1ea1n<\/p>\n
Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng v\u00e0 tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 ban \u0111\u1ea7u
\nkh\u00f4ng \u0111\u1eb7c hi\u1ec7u. C\u1ea7n ph\u1ea3i l\u01b0u \u00fd k\u1ef9 tr\u00ean l\u00e2m s\u00e0ng<\/td>\n
C\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n nhi\u1ec1u th\u00e1ng sau khi d\u00f9ng PPI.
\nTi\u00ean l\u01b0\u1ee3ng kh\u00e1 t\u1ed1t n\u1ebfu nh\u01b0 kh\u00f4ng d\u00f9ng PPI n\u1eefa
\nC\u00f3 th\u1ec3 th\u1eed steroide<\/td>\n<\/tr>\n
B\u1ec7nh th\u1eadn do Leptospiral<\/td>\n Hay g\u1eb7p s\u1ed1t v\u00e0 v\u00e0ng da<\/p>\n
M\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng kh\u00e1c c\u00f3 th\u1ec3 th\u1ea5y l\u00e0 gan to, ch\u1ea3y
\nm\u00e1u l\u1ee3i v\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, ti\u1ec3u m\u00e1u \u0111\u1ea1i th\u1ec3, vi\u00eam
\nk\u1ebft m\u1ea1c, thay \u0111\u1ed5i t\u00e2m th\u1ea7n, thi\u1ec3u ni\u1ec7u g\u1ea7n nh\u01b0 tr\u00ean t\u1ea5t
\nc\u1ea3 b\u1ec7nh nh\u00e2n.<\/p>\n
Ti\u00eau c\u01a1 v\u00e2n, vi\u00eam gan \u1ee9 m\u1eadt, thi\u1ebfu m\u00e1u t\u00e1n huy\u1ebft v\u00e0
\ngi\u1ea3m ti\u1ec3u c\u1ea7u r\u1ea5t hay xu\u1ea5t hi\u1ec7n.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh b\u1eb1ng c\u00e1ch c\u1ea5y n\u01b0\u1edbc ti\u1ec3u ho\u1eb7c c\u1ea5y
\nm\u00e1u ho\u1eb7c huy\u1ebft thanh h\u1ecdc.
\nSinh thi\u1ebft th\u1eadn th\u1ea5y ph\u1ea7n l\u1edbn vi\u00eam \u1edf \u1ed1ng l\u01b0\u1ee3n g\u1ea7n
\nv\u00e0 xu\u1ea5t huy\u1ebft m\u00f4 k\u1ebd.<\/td>\n
B\u1ec7nh th\u1eadn xu\u1ea5t hi\u1ec7n kho\u1ea3ng 40% tr\u00ean b\u1ec7nh nh\u00e2n nhi\u1ec5m leptospiral. T\u1ef7 l\u1ec7 t\u1eed vong kho\u1ea3ng
\n25%.CKD ch\u1ec9 c\u00f2n 10%<\/td>\n<\/tr>\n
Sarcoidosis<\/td>\n C\u00e1c tri\u1ec7u ch\u1ee9ng ngo\u00e0i th\u1eadn chi\u1ebfm \u01b0u th\u1ebf, h\u1ea7u h\u1ebft \u1ea3nh
\nh\u01b0\u1edfng tr\u00ean ph\u1ed5i, m\u1eaft v\u00e0 da.T\u0103ng eosinophil tr\u00ean 1\/4 b\u1ec7nh nh\u00e2nT\u0103ng canxi m\u00e1u th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n b\u1ea5t ch\u1ea5p suy th\u1eadn n\u1eb7ng
\nH\u1ea1ch b\u1ea1ch huy\u1ebft \u1edf r\u1ed1n ph\u1ed5i tr\u00ean phim Xquang<\/p>\n
M\u1ee9c ACE kh\u00f4ng tin c\u1eady trong b\u1ec7nh v\u1ec1 th\u1eadn.<\/p>\n
Sinh thi\u1ebft th\u1eadn c\u00f3 th\u1ec3 th\u1ea5y u h\u1ea1t ho\u1ea1i t\u1eed kh\u00f4ng\u0111\u00f4ng v\u00e0 c\u00e1c t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3<\/td>\n
Th\u01b0\u1eddng gi\u1ea3m v\u00e0 di\u1ec5n ti\u1ebfn t\u00e1i ph\u00e1t CKD duy tr\u00ec 90%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Di\u1ec5n ti\u1ebfn trong k\u1ebd th\u1eadn<\/h2>\n
AIN l\u00e0 m\u1ed9t b\u1ec7nh c\u1ea3nh vi\u00eam nhi\u1ec5m do thu\u1ed1c ho\u1eb7c nhi\u1ec5m tr\u00f9ng. C\u00f3 3 tri\u1ec7u ch\u1ee9ng kinh \u0111i\u1ec3n l\u00e0 ph\u00e1t ban, t\u0103ng eosinophil v\u00e0 s\u1ed1t – th\u01b0\u1eddng \u00edt g\u1eb7p .Ph\u00e2n t\u00edch k\u1ebft qu\u1ea3 n\u01b0\u1edbc ti\u1ec3u g\u1ee3i \u00fd AIN khi c\u00f3 t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u, tr\u1ee5 b\u1ea1ch c\u1ea7u v\u00e0 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n \u00e1i toan. \u0110\u00f4i khi c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u th\u00ec m\u1ecfng. \u0110\u1ec3 ph\u00e1t hi\u1ec7n ti\u1ec3u ra eosinophil n\u00ean d\u00f9ng thu\u1ed1c nhu\u1ed9m Hansel. Tuy nhi\u00ean, ti\u1ec3u eosinophil l\u00e0 d\u1ea5u hi\u1ec7u kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00ec th\u1ebf \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u th\u1ea5p. Sinh thi\u1ebft th\u1eadn gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh. Kh\u00e1ng sinh betalactam l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh h\u00e0ng \u0111\u1ea7u m\u1eb7c d\u00f9 g\u1ea7n \u0111\u00e2y b\u1ea5t k\u1ef3 kh\u00e1ng sinh n\u00e0o ho\u1eb7c nhi\u1ec1u thu\u1ed1c ngo\u00e0i kh\u00e1ng sinh \u0111\u1ec1u c\u00f3 th\u1ec3 g\u00e2y AIN. B\u1ea3ng 43.6 li\u1ec7t k\u00ea danh s\u00e1ch c\u00e1c nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn c\u1ee7a AIN tr\u00ean ICU.<\/p>\n
Lo\u1ea1i b\u1ecf c\u00e1c t\u00e1c nh\u00e2n g\u00e2y th\u01b0\u01a1ng t\u1ed5n ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nhi\u1ec5m tr\u00f9ng n\u1ec1n l\u00e0 \u0111i\u1ec1u tr\u1ecb ch\u00ednh y\u1ebfu. Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng th\u1eadn l\u00e0 kh\u00f4ng th\u1ec3 trong nhi\u1ec1u ng\u00e0y \u0111\u1ebfn v\u00e0i tu\u1ea7n, v\u00e0 \u0111\u00f4i khi nhi\u1ec1u th\u00e1ng. Vai tr\u00f2 c\u1ee7a corticosteroide v\u1eabn c\u00f2n \u0111ang tranh lu\u1eadn. V\u00e0i nghi\u00ean c\u1ee9u cho th\u1ea5y k\u1ebft c\u1ee5c t\u1ed1t h\u01a1n tr\u00ean b\u1ec7nh nh\u00e2n d\u00f9ng corticoide.<\/p>\n
Cyclophosphamide, mycophenolate mofeil, ho\u1eb7c c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean nh\u1eefng
\nb\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb corticoide t\u1eeb 2-3 tu\u1ea7n.<\/p>\n
T\u1ed5ng k\u1ebft<\/h2>\n
M\u1ed9t s\u01a1 \u0111\u1ed3 ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n AKI c\u00f3 th\u1ec3 gi\u00fap t\u00ecm ra b\u1ec7nh nguy\u00ean v\u00e0 v\u1ea1ch ra k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb. Khi m\u1edbi b\u1eaft \u0111\u1ea7u ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u quan tr\u1ecdng \u0111\u1ea7u ti\u00ean l\u00e0 ph\u1ea3i x\u00e1c \u0111\u1ecbnh AKI n\u00e0y do nguy\u00ean nh\u00e2n tr\u01b0\u1edbc th\u1eadn, t\u1ea1i th\u1eadn hay sau th\u1eadn, h\u1ecfi b\u1ec7nh s\u1eed, kh\u00e1m l\u00e2m s\u00e0ng, c\u00e1c k\u1ebft qu\u1ea3 c\u1eadn l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc. Soi c\u1eb7n l\u1eafng n\u01b0\u1edbc ti\u1ec3u mang l\u1ea1i gi\u00e1 tr\u1ecb cao \u0111\u1ec3 t\u00ecm ra r\u1ed1i lo\u1ea1n n\u1ec1n c\u1ee7a th\u1eadn v\u00e0 sau \u0111\u00f3 gi\u00fap ph\u00e2n lo\u1ea1i c\u00e1c b\u1ea5t th\u01b0\u1eddng \u0111\u00f3. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn v\u00e0 m\u00f4 k\u1ebd, thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch c\u00f3 th\u1ec3 h\u1eefu \u00edch gi\u00fap \u0111\u1ea3o ng\u01b0\u1ee3c di\u1ec5n ti\u1ebfn b\u1ec7nh th\u1eadn. Tuy nhi\u00ean, nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a AKI trong ICU l\u00e0 t\u1ed5n th\u01b0\u01a1ng \u1ed1ng th\u1eadn (ATN), v\u00e0 kh\u00f4ng c\u00f3 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u \u0111\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c di\u1ec5n ti\u1ebfn ho\u1eb7c th\u1eadm ch\u00ed d\u1ef1 ph\u00f2ng t\u1ed5n th\u01b0\u01a1ng sau n\u00e0y. V\u1eabn ph\u1ea3i \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3, ch\u1ee7 y\u1ebfu l\u00e0 gh\u00e9p th\u1eadn s\u1ebd b\u00e0n trong ch\u01b0\u01a1ng sau.<\/p>\n
Suggested Readings<\/h2>\n
\n
Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet. 2012;380:756\u2013766.<\/li>\n
Durand F, Graupera I, Gines P, et al. Pathogenesis of hepatorenal syndrome: implications for therapy. Am J Kidney Dis. 2016;67(2):318\u2013328.<\/li>\n
Faubel S, Patel NU, Cadnapaphornchar MA. Renal relevant radiology: use of ultrasonography in patients with AKI. Clin J Am Soc Nephrol. 2014;9(2):382\u2013394.<\/li>\n
George JN, Nester CM. Syndromes of thrombotic microangiopathy. N Engl J Med. 2014;371: 654\u2013666.<\/li>\n
Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41:1411\u20131423.<\/li>\n
Kidney Disease: Improving Global Outcomes (KDIGO). Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injur Kidney Int Suppl. 2012;2:1\u2013138.<\/li>\n
Marenzi G, Assanelli E, Marana I, et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med. 2006;354:2773\u20132782.<\/li>\n
Randomized controlled trial comparing high and low doses of N-acetylcysteine in preventing contrast-induced nephropathy.<\/li>\n
Markowitz GS, Perazella MA. Drug-induced renal failure: a focus on tubulointerstitial disease. Clin Chim Acta. 2005;351:31\u201347.<\/li>\n
Review of pattern of drug-induced renal injury.<\/li>\n
Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA. 2004;291:2328\u20132334.<\/li>\n
Randomized study evaluating efficacy of sodium bicarbonate in preventing renal injury.<\/li>\n
Perazella MA, Coca SG. Traditional urinary biomarkers in the assessment of hospital-acquired AKI. Clin J Am Soc Nephrol. 2012;7(1):167\u2013174.<\/li>\n
Praga M, Gonz\u00e1lez E. Acute interstitial nephritis. Kidney Int. 2010;77:956\u2013961.<\/li>\n
Perazella MA. The urine sediment as a biomarker of kidney disease. Am J Kidney Dis. 2015;66(5): 748\u2013755.
\nSalerno F, Gerbes A, Gin\u00e8s P, et al. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007;56:1310\u20131318.<\/li>\n
Vijayan A, Faubel S, Askenazi DJ, et al.; American Society of Nephrology Acute Kidney Injury Advisory Group. Clinical use of the urine biomarke<\/li>\n
[TIMP-2] \u00d7 [IGFBP7] for acute kidney injury risk assessment. Am J Kidney Dis. 2016;68(1):19\u201328.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"
T\u00e1c gi\u1ea3: Fahad Edrees and Anitha Vijayan Bi\u00ean d\u1ecbch: B\u00e1c s\u0129 Ho\u00e0ng Nam vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p \u0111i\u1ec1u tr\u1ecb trong y h\u1ecdc, xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y. T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p (AKI), tr\u01b0\u1edbc \u0111\u00e2y g\u1ecdi l\u00e0 suy th\u1eadn c\u1ea5p, l\u00e0 t\u00ecnh tr\u1ea1ng suy […]\n","protected":false},"author":1,"featured_media":33751,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-33750","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\/33750","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=33750"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33750\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/33751"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=33750"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=33750"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=33750"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}