XAT HYFT NAO MANG NAO MON

DO THlF VlTAMlN k

l. Al CONG :
Xuat huyet nao mang nao muon xay ra tre t 15 ngay tuoi en 6 thang
tuoi va nhieu nhat la trong khoang t 1 en 2 thang tuoi. Thng cac trieu
chng xuat hien ot ngot va nhanh nen benh nhan thng nhap vien trong tnh
trang nang. a so cac tre eu c bu sa me hoan toan.
Xuat huyet nao mang nao muon xay ra tre khong chch nga vitamin K luc
sanh va cac tre co lng PIVKA cao (Proteins induced by vitamin K absence).
ll. CHAN OAN:
1. Cong vicc cban doan :
a) Hoi :
! Bu kem hoac bo bu.
! Khoc thet.
! Co giat.
b) kbam tm cac dao bico:
! L m hoac hon me.
! Xanh xao, vang da.
! Thop phong
! Dau than kinh khu tru: sup m mat.
c) c ngb| xct ngbicm:
! Hct.
! PT, PTT hoac TQ, TCK.
! Sieu am nao.
! Choc do tuy song: ch thc hien khi sieu am nao bnh thng, can
phan biet gia viem mang nao va xuat huyet nao-mang nao.
2. Cban doan xac d|nb:
Bu kem / bo bu, thop phong, xanh xao + sieu am nao co xuat huyet (hoac
choc do dch nao tuy ra mau khong ong) va TQ, TCK keo dai.
3. Cban doan co tbc: Bu kem / bo bu + thop phong + xanh xao.
4. Cban doan pban bict :
Viem mang nao : khi co bieu hien nghi ng nhiem trung (sot cao va/hoac co
o nhiem trung) can choc do tuy song e loai tr viem mang nao mu.
lll.lF Tk] :
1. Ngoycn tac dico tr|:
! ieu tr ac hieu: vitamin K.
! Nang tong trang.
! Lam cho chay mau khong lan rong va thanh lap sang thng mi.
2. ico tr| dac bico : Vitamin K
1
5mg TB
3. ico tr| trico cbong :
! Truyen mau ti cung nhom va lng mau truyen c tnh theo cong
thc :
V = can nang(kg) x 80 x (Hct
muon at
Hct
o c
) / Hct
chai mau

Hoac 10 20 ml/kg trong 2-4 gi
! Huyet tng ti ong lanh (Fresh Frozen Plasma): 10-20ml/kg trong
trng hp:
- Xuat huyet nao nhng Hct khong giam.
- Xuat huyet nang: truyen ong thi huyet tng ti ong lanh va hong
cau lang.
! Neu co giat: Phenobarbital lieu au (loading dose) = 20mg/kg TM va
sau na gi con co giat 10mg/kg TM, co the tiep tuc na khi con co
giat.
! Neu khong co giat : Phenobarbital 5mg/kg TB.
! Neu khong co Phenobarbital, co the dung Diazepam: 0,3-0,5m/kg TM
cham va chu y van e suy ho hap.
! Vitamin E : 50 n v / ngay (uong) en khi xuat vien (t nhat 7 ngay)
! Cac lu y trong cham soc:
- Nam ngh tuyet oi, tranh kch thch
- Nam au cao 30
0

- Cho an qua ong thong bao t : sa me hoac sa cong thc
- Tranh tham kham khong bat buoc
lV. THFO DOl VA TAl kHAM :
1. Tbco doi :
! o vong au moi ngay
! S phat trien van ong tam than
! Sieu am nao
2. Tai kbam :
Moi 3 thang en 2 nam (co ieu kien th tai kham en 4-7 nam) e phat
hien cac di chng nao: teo nao, nao ung thuy, bai nao, cham phat trien van
ong tam than.