- Ket hqfp xtfdng vtfng (co dinh ngo&i)
4. LAM SANG V AX QUANG
4.3. Hoi chumg chen ep khoang d mg chan (HC CEK)
Khong phai chi gay cang chan mdi cd hoi chting nay. Hoi chting chdn ep khoang ndi chung cd tdi 45% la do chan thtfdng gay xtfdng, trong 45% dd thi 80% la gay xtfdng cang chan, ban chan.
Hoi chting chen 6p khoang xuat hien khi cd ton thtfdng cac mach mau trong xtfdng, trong p h ln mem, gay mau tu trong cac khoang chat hep. Cac hien ttfdng roi loan v&n mach, t&ng xu&'t tiet gay phu ne to chtic, cang phu ne cang tang chen 6p khoang... dd la m ot vong luan quan (hinh 24.1).
H inh 24.1. Cac khoahg cSng chan
• Hoi chvtng chin ip khoang gay ra
T&ng ap ltfc trong khoang cd xtfdng gay Chen ep tu&n hoan mao mach gay hoai tti to’ chtic nhtf trong tic m?ch do nhilm khu£n.
Qua 8 gid vnh khdng xti ty hpi chtfng chen 6p khoang coi nhtf da cd nhting ton thtfdng khdng h& phyc.
M atsen difa ra 5 bieu hien lam sang cua hoi chting chen ep khoang cang chan nhif sau:
- Dau qua mtfc thong thtfdng cua mot gay xtfdng, mac du da dtfdc bat dong chi gay
- Cang ctfng toan bo cang chan
- Te bi va co cam giac "kien bo" d dau ng6n, ve sau khong con nhan biet dtfdc cac ngon
- Dau tang khi van dong thu dong, cang dan cd bap - Liet van dong cac ngon
Ong da dtfa ra bang ch&n doan phan biet v6i cac ton thtfdng m ach mau hoSc dap dtft than kinh.
• L am sa n g H oi chtfng ch en ep k h oa n g
HCCEK Ton thi/dng mach
Ton thuong than kinh
Dau khi cdng thu dong cd bSp + + -
Te bi + + +
Liet van dong + + +
Mach dap + - +
Ap ltfc khoang cao + - -
• Can lam s a n g ch a n d oa n h oi ch tfn g ch en ep k h o a n g :
Chan doan hoi chtfng chen ep khoang kho khi benh nhan co da chan thtfdng, tut huyet ap, luc nay co the do ap ltfc khoang bang cach choc kim co catheter de do: binh thtfdng ap ltfc trong cd bap la lOm m Hg va c6 the len 30m m H g trong thi tam thu; tren 30mm Hg la phai mo cap ctiu md can ngay.
Do giao dong mach bang Doppler: thay m at hoac giam ltfu ltfdng dong chay d phia ha ltfu.
Chup mach, chup CT Scanner
Cac xet nghiem: cong thtic mau de danh gia tinh trang m at mau, xet nghiem chtic nang gan-than, xet nghiem cac yeu to" dong mau de loai trti chen ep khoang do benh ve mau
Nghi ngd hoi chifng khoang
Trieu chifng lam sang ro
Benh nhan hon me Da chan thi/dng
Trieu chifng lam sang khong ro I
Do ap life khoang
> 30mmHg < 30mmHg i Theo doi ap lire khoang va lam sang«-|
< 3 0 ♦ mmHg 1 Trieu chifng lam sang no T > 30mmHg MdJ cAn
Hinh 24.2. Theo doi hoi chifng chen ep khoang 5. DIEU TR|
Dieu tri gay kin