{"id":7982,"date":"2019-04-21T09:47:07","date_gmt":"2019-04-21T02:47:07","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=7982"},"modified":"2019-04-23T09:54:41","modified_gmt":"2019-04-23T02:54:41","slug":"tom-tat-huong-dan-cua-anh-ve-chan-doan-va-quan-ly-chay-mau-duong-tieu-hoa-duoi-nam-2019","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/tom-tat-huong-dan-cua-anh-ve-chan-doan-va-quan-ly-chay-mau-duong-tieu-hoa-duoi-nam-2019\/","title":{"rendered":"T\u00f3m t\u1eaft h\u01b0\u1edbng d\u1eabn c\u1ee7a Anh v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd ch\u1ea3y m\u00e1u \u0111\u01b0\u1eddng ti\u00eau ho\u00e1 d\u01b0\u1edbi n\u0103m 2019"},"content":{"rendered":"<h2>Nh\u1eefng thay \u0111\u1ed5i quan tr\u1ecdng<\/h2>\n<p>H\u01b0\u1edbng d\u1eabn m\u1edbi n\u00e0y c\u1ee7a Anh n\u00e0y \u0111\u00e3 b\u1ed5 sung th\u00eam b\u1eb1ng ch\u1ee9ng th\u1ef1c h\u00e0nh so v\u1edbi H\u01b0\u1edbng d\u1eabn n\u0103m 2016 c\u1ee7a Tr\u01b0\u1eddng ban Ti\u00eau h\u00f3a Hoa K\u1ef3 (ACG):<\/p>\n<p>Ph\u00e2n lo\u1ea1i b\u00eanh nh\u00e2n ban \u0111\u1ea7u d\u1ef1a tr\u00ean ch\u1ec9 s\u1ed1 s\u1ed1c, s\u1eed d\u1ee5ng h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp m\u1ea1ch m\u00e1u n\u00e3o (CTA) s\u1edbm \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng \u1ed5n \u0111\u1ecbnh.<br \/>\nS\u1eed d\u1ee5ng \u0111i\u1ec3m ph\u00e2n t\u1ea7ng nguy c\u01a1 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5p.<br \/>\nK\u1ebft h\u1ee3p b\u1eb1ng ch\u1ee9ng m\u1edbi nh\u1ea5t trong vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng huy\u1ebft kh\u1ed1i \u1edf b\u1ec7nh nh\u00e2n ch\u1ea3y m\u00e1u.<\/p>\n<h2>C\u00e1c khuy\u1ebfn ngh\u1ecb ch\u00ednh<\/h2>\n<p>Ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n ban \u0111\u1ea7u nh\u01b0 \u1ed5n \u0111\u1ecbnh ho\u1eb7c kh\u00f4ng \u1ed5n \u0111\u1ecbnh d\u1ef1a tr\u00ean ch\u1ec9 s\u1ed1 s\u1ed1c (SI = nh\u1ecbp tim\/huy\u1ebft \u00e1p t\u00e2m thu; SI \u22651 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 kh\u00f4ng \u1ed5n \u0111\u1ecbnh).<\/p>\n<p>Th\u1ef1c hi\u1ec7n CTA \u1edf b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c SI \u22651 sau khi h\u1ed3i s\u1ee9c. D\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 CTA:<\/p>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 CTA d\u01b0\u01a1ng t\u00ednh n\u00ean ti\u1ebfn h\u00e0nh ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch thuy\u00ean t\u1eafc c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t, l\u00fd t\u01b0\u1edfng trong v\u00f2ng 60 ph\u00fat.<br \/>\nB\u1ec7nh nh\u00e2n c\u00f3 CTA \u00e2m t\u00ednh n\u00ean ti\u1ebfn h\u00e0nh n\u1ed9i soi \u0111\u1ec3 lo\u1ea1i tr\u1eeb ch\u1ea3y m\u00e1u \u0111\u01b0\u1eddng ti\u00eau h\u00f3a tr\u00ean.<\/p>\n<p>N\u00ean tr\u00e1nh ph\u1eabu thu\u1eadt kh\u1ea9n c\u1ea5p n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ea3y m\u00e1u c\u1ee5c b\u1ed9, ngo\u1ea1i tr\u1eeb trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm g\u1eb7p (v\u00ed d\u1ee5: r\u00f2 \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ru\u1ed9t).<\/p>\n<p>Ph\u00e2n lo\u1ea1i ch\u1ea3y m\u00e1u huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh (SI &lt;1) th\u00e0nh nghi\u00eam tr\u1ecdng (c\u1ea7n nh\u1eadp vi\u1ec7n) ho\u1eb7c nh\u1eb9 (th\u00edch h\u1ee3p \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa) d\u1ef1a tr\u00ean c\u00f4ng c\u1ee5 \u0111\u00e1nh gi\u00e1 nguy c\u01a1 (v\u00ed d\u1ee5: \u0111i\u1ec3m nguy c\u01a1 Oakland \u22648 \u0111i\u1ec3m v\u00e0 kh\u00f4ng c\u00f3 l\u00fd do n\u00e0o kh\u00e1c \u0111\u1ec3 nh\u1eadp vi\u1ec7n).<\/p>\n<p>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n ch\u1ea3y m\u00e1u nghi\u00eam tr\u1ecdng, chu\u1ea9n b\u1ecb n\u1ed9i soi ngay khi c\u00f3 th\u1ec3.<br \/>\nS\u1eed d\u1ee5ng c\u00e1c ng\u01b0\u1ee1ng truy\u1ec1n m\u00e1u ch\u1eb7t ch\u1ebd h\u01a1n (b\u1eaft \u0111\u1ea7u khi hemoglobin [Hb] &lt;7 v\u00e0 m\u1ee5c ti\u00eau Hb 7\u20139 g\/dL sau khi truy\u1ec1n; tr\u01b0\u1eddng h\u1ee3p c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch th\u00ec b\u1eaft \u0111\u1ea7u truy\u1ec1n khi Hb &lt; 8 g\/dL v\u00e0 m\u1ee5c ti\u00eau l\u00e0 10 g\/dL).<\/p>\n<h3>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng thu\u1ed1c ch\u1ed1ng huy\u1ebft kh\u1ed1i:<\/h3>\n<p>T\u1ea1m ng\u01b0ng s\u1eed d\u1ee5ng warfarin n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng \u1ed5n \u0111\u1ecbnh, \u0111\u1ea3o ng\u01b0\u1ee3c kh\u00e1ng \u0111\u00f4ng b\u1eb1ng c\u00e1c ph\u1ee9c h\u1ee3p prothrombin ho\u1eb7c vitamin K.<br \/>\nTi\u1ebfp t\u1ee5c d\u00f9ng aspirin \u0111\u1ec3 ph\u00f2ng ng\u1eeba th\u1ee9 ph\u00e1t.<br \/>\n\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng li\u1ec7u ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p v\u1edbi aspirin v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf P2Y12, t\u1ea1m ng\u01b0ng thu\u1ed1c \u1ee9c ch\u1ebf P2Y12 n\u1ebfu x\u1ea3y ra ch\u1ea3y m\u00e1u nghi\u00eam tr\u1ecdng.<br \/>\nNg\u01b0ng s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp (DOAC) v\u00e0 \u0111\u1ea3o ng\u01b0\u1ee3c kh\u00e1ng \u0111\u00f4ng \u1edf b\u1ec7nh nh\u00e2n ch\u1ea3y m\u00e1u \u0111e d\u1ecda t\u00ednh m\u1ea1ng b\u1eb1ng idarucizamab (cho dabigatran) ho\u1eb7c andexanet alpha (cho thu\u1ed1c \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 Xa).<br \/>\nB\u1eaft \u0111\u1ea7u l\u1ea1i thu\u1ed1c ch\u1ed1ng huy\u1ebft kh\u1ed1i sau khi \u0111\u00e3 c\u1ea7m m\u00e1u v\u00e0 trong v\u00f2ng 7 ng\u00e0y.<\/p>\n<h2>B\u00e0n lu\u1eadn<\/h2>\n<p>\u0110\u00e2y l\u00e0 h\u01b0\u1edbng d\u1eabn to\u00e0n di\u1ec7n v\u1ec1 qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n LGIB. T\u1eeb 10-15% tr\u01b0\u1eddng h\u1ee3p LGIB nghi ng\u1edd nghi\u00eam tr\u1ecdng xu\u1ea5t ph\u00e1t t\u1eeb \u0111\u01b0\u1eddng ti\u00eau h\u00f3a tr\u00ean. N\u1ed9i soi s\u1edbm n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n. \u0110\u1ed9 ch\u00ednh x\u00e1c tr\u00ean l\u00e2m s\u00e0ng c\u1ee7a c\u00e1c thang \u0111i\u1ec3m ph\u00e2n t\u1ea7ng r\u1ee7i ro bao g\u1ed3m thang \u0111i\u1ec3m \u0111\u01b0\u1ee3c BSG khuy\u1ebfn ngh\u1ecb &#8211; Oakland ch\u01b0a \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp. C\u00e1c thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 LGIB kh\u00e1c, bao g\u1ed3m c\u1ea3 \u0111i\u1ec3m SHA2PE \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t g\u1ea7n \u0111\u00e2y (Scand J Gastroenterol 2018; 53:1484), c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng thay th\u1ebf.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<p>Oakland K et al. Diagnosis and management of acute lower gastrointestinal bleeding: Guidelines from the British Society of Gastroenterology. Gut 2019 Feb 12; [e-pub]. Link\u00a0<a href=\"https:\/\/doi.org\/10.1136\/gutjnl-2018-317807\" rel=\"noopener\">https:\/\/doi.org\/10.1136\/gutjnl-2018-317807<\/a><\/p>\n<p>T\u00e1c gi\u1ea3: Nguy\u1ec5n Th\u1ecb Thanh H\u1eb1ng, Th\u1ea1c s\u0129 D\u01b0\u1ee3c s\u0129 L\u00fd Th\u1ecb Kim Dung (08\/04\/2019 5:10) &#8211; Th\u00f4ng Tin Thu\u1ed1c.<br \/>\n\u0110\u00e2y l\u00e0 h\u01b0\u1edbng d\u1eabn \u0111\u1ea7u ti\u00ean bao g\u1ed3m c\u00e1c khuy\u1ebfn ngh\u1ecb d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng c\u1ee7a Hi\u1ec7p h\u1ed9i Ti\u00eau h\u00f3a Anh (BSG) v\u1ec1 ch\u1ea9n \u0111o\u00e1n, \u0111\u00e1nh gi\u00e1 v\u00e0 qu\u1ea3n l\u00fd ch\u1ea3y m\u00e1u c\u1ea5p t\u00ednh \u0111\u01b0\u1eddng ti\u00eau h\u00f3a d\u01b0\u1edbi (LGIB).<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nh\u1eefng thay \u0111\u1ed5i quan tr\u1ecdng H\u01b0\u1edbng d\u1eabn m\u1edbi n\u00e0y c\u1ee7a Anh n\u00e0y \u0111\u00e3 b\u1ed5 sung th\u00eam b\u1eb1ng ch\u1ee9ng th\u1ef1c h\u00e0nh so v\u1edbi H\u01b0\u1edbng d\u1eabn n\u0103m 2016 c\u1ee7a Tr\u01b0\u1eddng ban Ti\u00eau h\u00f3a Hoa K\u1ef3 (ACG): Ph\u00e2n lo\u1ea1i b\u00eanh nh\u00e2n ban \u0111\u1ea7u d\u1ef1a tr\u00ean ch\u1ec9 s\u1ed1 s\u1ed1c, s\u1eed d\u1ee5ng h\u00ecnh \u1ea3nh c\u1eaft l\u1edbp m\u1ea1ch m\u00e1u n\u00e3o (CTA) [&#8230;]\n","protected":false},"author":1,"featured_media":7983,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-7982","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\/7982","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=7982"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/7982\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/7983"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=7982"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=7982"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=7982"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}