- Viem tuy cap the chay mau Viem tuy cap the hoai t
10. TIEN L lfp NG VIEM TUY CAP
Triidc benh nhan viem tuy cap, tien liidng dong vai trd quan trong, de giup cho thay thuoc cd thai do xii ly, dung dan va kip thdi, viec danh gia tien liidng phai diia tren sii theo d5i nhieu gid, nhieu ngay va diia tren nhieu yeu to": Lam sang, huyet hoc, sinh hoa va chan doan hinh anh. Tren cd sd nay, cac tac gia da diia ra cac cach tien liidng khac nhau
10.1. Difa dau hieu toan than
Viem tuy cap diidc coi la nang khi cd cac dau hieu sau; - Huyet ap tdi da < 90 mmHg
- Suy ho hap: P a 0 2 < 60 mmHg - Suy than: Creatinin > 2mg/dl
- N hilm khuan: Sot >38°C, BC mau > 20. 000/ mm3
10.2. Phan do nang nhe theo lam sang dira theo tieu chuanHoi nghj Atlanta Hoa Ky (1992 ) [9]. Hoi nghj Atlanta Hoa Ky (1992 ) [9].
- Viem tuy cap the nhe: + Bung triidng nhe hoac viia + Mach, huyet ap binh thiidng + Khong kho thd
+ Khong co tran dich da mang
+ Khong co bien chiing tai cho hoac toan than
- Viem tuy cap the nang: Co bien chiing viem tuy cap hoai tii, bien chiing toan than
+ Suy ho hap cap, mach nhanh hoac truy mach, huyet ap tut + Tran dich da mang, co triidng
+ Suy than cap
+ Bung triidng cang, cam ting phuc mac toan o bung + Hoac lam sang la viem tuy cap the nhe, nhtfng qua trinh dien bien trd nen nang, xuat hien cac dau hieu mach nhanh nho, huyet ap tut, kho thd, cam ting phuc mac toan o bung, xuat hien cac bien chting tai cho hoac toan than
10.3. Bang tien lUdng cua Ranson: Gom 11 yeu to lien quan den tien trien, tien liidng cua benh [17]. den tien trien, tien liidng cua benh [17].
* Luc nhap vien (gid 0). - Tuoi > 55
- BC > 16.000/mm3
- Diidng mau > llm m ol/1 (benh nhan khong bi dai diidng triidc do)
- LDH (Lactideshydrogenase) > 350UI/1
- AST (Aspartat amino tranferase) 250UI/1 (hoac SGOT) * Trong 48 gid dau
- Hematocrit giam > 10%
- Ure mau tang > l,8m m ol/l (> 0,5mg/l) - Calci mau < 2mmol/l (< 80mg/l)