SV Y2 Nguyn Tn Thnh

1.
2. 3. 4. 5.

ng mu l g? Chy mu v cc loi chy mu Cc nguyn nhn chy mu nh gi chc nng cm mu Cc phng thc cm mu trong ngoi khoa

 nh

ngha: ng mu l qu trnh t nhin, bao gm 3 yu t: 1. C ch thnh mch 2. C ch tiu cu 3. ng mu: ni sinh v ngoi sinh Tt c cc yu t dn n vic c ch hay gim lng mu thot mch
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1. NG MU L G?

Chy mu l hin tng mu thot khi lng mch

2 loi chy mu:

Chy mu i th t mch mu ln Chy mu kiu thm (oozing)

2. CHY MU V CC LOI CHY MU

Chy

mu i th t mch mu ln

Mu ng mch ti v phun theo nhp p tim. Lng mu mt ph thuc kch thc ng mch. Mu tnh mch thng chy lin tc v sm vi p lc thp.

2. CHY MU V CC LOI CHY MU

Chy

mu kiu thm (oozing) Mt mu do thm c th tr nn rt nguy him nu mt kim sot. Chy mu mao mch: s dng gc kh hoc t, v n nh vo ch mu chy l c th cm mu c. Chy mu nhu m: c th cm c bng cch khu hay s dng gelatin. Chy mu nh khi rch da c th kim sot bng cch dng gc n nh ln gc da

2. CHY MU V CC LOI CHY MU

Chy

mu nhiu hay t c th c phn loi da trn th tch mu b mt. kim sot mu b mt, cn bit th tch mu ca bnh nhn Nam 70m/kg (6% trng lng c th) N 65 m/kg).

2. CHY MU V CC LOI CHY MU

1
Lng mu mt (ml) Nhp tim Huyt p <750 <100 BT

2
750-1500 100-120 BT

3
1500-2000 120-150 Gim

4
>2000 >150 Gim

RR
Thi gian y mao mch Da Nc tiu (ml/h) Hnh vi

14-20
BT

20-30
Hi chm

30-35
>2s

>35
-

Hng, mt >30 Lo u thong qua

Xanh xao, lnh 20-30 Lo u

Xanh xao, lnh, m 5-15

Ni bng <5

Hoang mang Hoang mang Hn m

 Ri

lon ng mu bm sinh Mc phi Trong m Sau m

3. NGUYN NHN GY CHY MU TRONG NGOI KHOA

Hemophili A hay B
Bt thng yu t VIII hay IX TCK ko di nhng thi gian mu chy bnh thng

Bnh von Willebrand

Do thiu yu t cng tn trong huyt tng nn gy bt thng yu t VIII v chc nng tiu cu TCK v thi gian mu chy ko di

Ri lon tiu cu
Do suy chc nng hay gim tiu cu Thi gian mu chy c th ko di hoc khng

Ri lon thnh mch

3. NGUYN NHN GY CHY MU TRONG NGOI KHOA

Do bnh gan (x gan nng, vim gan)

Cc yu t ng mu c th gim, nht l cc yu t ph thuc vitamin K TQ, TCK ko di, khng p ng vi vitamin K Tiu cu c th gim do ru hay th pht do cng lch TQ, TCK ko di nhng p ng vi vitamin K

R tiu ho, suy dinh dng, tc mt

iu tr khng ng vi heparin hay vi vitamin K Gim tiu cu do suy tu hay l st xut huyt gim tiu cu Suy tiu cu do NSAIDs hay do tng Ure huyt

3. NGUYN NHN GY CHY MU TRONG NGOI KHOA

Mc

d cc bin php cm mu c p dng nh ct, t in, chn gc, p ho cht nhng mu vn tip tc chy phu trng c th do:

Mt qu nhiu mu trong m (ghp tng, m tim, tuyn tin lit) Shock nng, a chn thng gy hi chng DIC (Disseminated intravascular coagulation) Truyn mu trn 10 n v trong vng 4-6h hay do gim tiu cu v cc yu t ng mu Tn huyt do truyn nhm nhm mu

3. NGUYN NHN GY CHY MU TRONG NGOI KHOA

Mt

na trng hp l do khim khuyt khu cm mu trong qu trnh phu thut Cc nguyn nhn khc:

Shock gy ra DIC Tiu si huyt v DIC Ct gan bn phn Thiu ht cc yu t ng mu ph thuc vitamin K (II, VII, IX, X) Heparin lu hnh cn st li sau m

A.
B. C.

Qua bnh s Qua khm lm sng Qua cn lm sng

4. NH GI CHC NNG CM MU

Hi k BN v tin s chy mu ca nhng cuc m trc nu c:

Chy mu bt thng sau chn thng, tiu phu, nh rng, sinh Chy mu d dng khi nh rng, chy mu mi, rong kinh D bm mu S dng thuc khng ng Gia nh c ngi mc bnh v mu

4. NH GI CHC NNG CM MU

Khng

hu ch bng bnh s v a s BN c ri lon nh th khng biu hin LS Nhng cn lu cc triu chng:

m , chm xut huyt di da thng lin quan n ri lon tiu cu Bm mu thng do bt thng ca ng mu huyt tng

4. NH GI CHC NNG CM MU

Kho

st tiu cu Kho st ng mu ngoi sinh Kho st ng mu ni sinh

tiu cu (thng lm nht)

Nhiu trng hp c gim tiu cu (bm sinh hay mc phi) nhng khng c beu hin lm sng, cho nn tiu cu phi m trc khi phu thut. Bnh thng: 150-400K/mm3 Gim: <100K/mm3 Gim nng: <50K/mm3

Thi

gian mu chy dng kho st cc giai on cm mu s khi ( BT 4-8 pht) Ngoi ra cn kho st cc mu ng nhng trong cc BV t khi lm.

 Thi

gian Quick (PT hay TQ)

Dng Thromboplastin chit xut cho vo mu phc hi calcium kho st kt qu, c qui thnh t lt Prothrombin. Bnh thng >60% Kho st yu t I,II,V,VII,X TQ c th ko di do suy gan, tc mt hoc do thuc khng VitK nn thng c theo di iu tr chng ng v khng VitK

nh

lng yu t V

Cc yu t ng mu do gan to ra (II,V,VII,IX,X) u ph thuc vo VitK tr yu t V. Nu TQ ko di v V gim th chng t suy gan

 Thi

gian Cephalin-Kaolin (TCK) hay Cephalin hot ho (aPTT-activated Partial Thrombin time)

Phng php ny thm d ng ng mu ni sinh v con ng chung nn kho st cc yu t I,II,V,VIII,IX,X,XI,XII gip pht hin bnh a chy mu (hemophilia)

 Trong

ngoi khoa, chy mu thng do khim khuyt trong khu cm mu. Bin chng chy mu rt nguy him, nht l nhng vng m, c quan kh thy trong phu trng, lm cho vt thng tr nn kh lnh. Chy mu trong m cn phi c kim sot ngay lp tc nu c th. C 3 phng thc cm mu:

C h c S dng nng lng ngoi c th Ho cht

5. CM MU TRONG NGOI KHOA

tay (digital pressure): l phng php kim sot chy mu ban u

(tournequet)

Garo

Ct

(ligation)

5. CM MU TRONG NGOI KHOA

Clip

Sp

xng

Khu

(suturing)

5. CM MU TRONG NGOI KHOA

Nhit

thp (hypothermia):

Ct lnh (cryosurgery): u dao ct c nhit 20 n -180 C vi mc ch lm gim nhu cu chuyn ho oxy, mt nc v bin tnh cc m m, khin mch mu co cng li.

Ct

in: s dng nng lng in cao tn t v ct m

C 2 loi l: monopolar v bipolar

Monopolar(clip): t n cc , khi t lm cho vng m b kh v to ra huyt khi trong lng mch. Ch ct: xung in c phng lin tc lm chy nhanh v ct ngang 1 vng m Bipolar(clip): ch c th t cm mu. Xung in c phng ra gia 2 bn in nn khng gy tn thng m ngoi 2 bn in

5. CM MU TRONG NGOI KHOA

BIPOLAR

MONOPOLAR

 my

t vi tia Argon:

My pht ra tia lm ng dn cho cc electron C th cm mu m khng chm vo m ng dng cm mu mt ct tng c

Laser

tr liu (laser therapy)

S dng tia laser ct, t, ph hu 1 s loi m

Quang

ng tr liu (photodynamic therapy) Quang ng hng ngoi (infrared photocoagulation) Sng cao tn (RFA)

5. CM MU TRONG NGOI KHOA

Absorbable

gelatin (Sponge) Absorbable collagen (Sponge) Microfibrillar collagen (Sponge) Oxytocin Epinephrine

 Ngun:

Ngoi khoa c s (HYD) Surgical Techniques - Text book for Medical Students Hnh nh: Google