Tang tnh tham thanh mach: thoat huyet tng lam mau co ac lai va lam giam lu lng tuan

hoan soc neu lng

huyet tng b mat > 20%.

Roi loan ong mau do 3 nguyen nhan khac nhau: thanh mach de v, giam so lng va chat lng tieu cau va giam yeu
to ong mau huyet tng.

Nghi ng SXH-D Du hiu cnh bo Tht thot huyt tng nng

Sng / n vng lu hnh Dengue - au bng - Sc v sc nng
St v > 2 trong s sau: - Nn i lin tc - dch km suy h hp
- Nn, i - C dch trn lm sng Xut huyt nng
- Pht ban - Xut huyt nim mc Suy tng nng
- au nhc - Li b, bt rt - Gan: AST hoc ALT > 1000 U/L
- Du dy tht (+) - Gan to >2 cm - TKTW: ri lon tri gic
- Gim bch cu mu - XN: tng HCT cng vi gim tiu - Tim, thn v cc c quan khc
- C du hiu cnh bo cu nhanh

A. Giai oan sot (2 3 ngay au)
Sot khi phat ot ngot, sot cao
lien tuc
Met moi, an kem
au nhc: nhc au, au c, au
khp
Bieu hien ho hap (so mui, ho): t
gap
Bieu hien tieu hoa: oi, buon oi,
au bung, tieu chay
Xuat huyet da niem: t gap
Phat ban
Bach cau va tieu cau co xu hng
giam dan
B. Giai oan nguy hiem (ngay 3 - Benh nhan bc vao giai oan hoi
7) phuc sau giai oan thoat huyet
Bieu hien lam sang nh giai oan tng 48 72 gi. Co s tai hap
sot nhng co nhng bieu hien ac thu dch t mo ke vao long mach
trng hn Benh nhan khoe hn, them an tr
Bieu hien LS cua thoat huyet lai
tng: gan toau, DTHC tang, tran Dau hieu hoi phuc: mach cham,
dch a mang. khong eu, t ban hoi phuc
Xuat huyet da niem mac: t ban
iem, chaymau chan rang, chay
mau mui,oi ra mau, tieu phan en,
rahuyet am ao
Benh tr nang khi benh nhan het
sot (nhiet o ha ot ngot), thng
ngay 4 - 6

Ch ieu tr trieu chng Bu dch bang ng uong (ORS, nc trai cay, nc chn)
Truyen dch (Lactat Ringer, NaCl) khi oi ma nhieu, mat nc, co ac mau nhieu. Ha sot: lau mat, dung acetaminophen
(paracetamol), khong dung salicylate v nguy c xuat huyet.Can theo doi sat e phat hien soc sm (chu y ngay 4 6 cua
benh).
U benh: muoi chch trieu chng: cn sot au tien (12 - 28 ngay), BN cam thay khoe hoac ch n lanh
4.2- Khi phat: khong ro Toan phat: Cn sot ret ien hnh: 3 giai oa Ret run: 15-60 ph, met moi, nhc au, non oi,
da lanh, mach nhanh Sot cao ot ngot sau cn ret, T=39-40C, da kho, 30ph.- 6gi Va mo hoi sau sot, nhit giam dan,
am mo hoi, mach cham, da am, BN buon ngu, d chou

ST RT LM SNG:
St Khng tm thy nguyn nhn gy st khc ang hoc n vng SR lu hnh/ tin s mc st rt Trong
vng 3 ngy u iu tr bng thuc st rt c p ng tt
2. XC NH MC ST RT:
C KSTSR / lame mu nhum giemsa, xt nghim chn on nhanh pht hin khng nguyn/ PCR

DHA-PPQ (Artekin, CV Artecan,...): Dihydroartemisinin 40 mg + Piperaquine 320 mg. NL: N1: 4 vien, N2- N3: 2 vien.
Thay th: Quinine: ung 30 mg/kg/ngy, chia 3 lnx7ngy phi hp vi Doxycycline: ung 1 ln, 3 mg/kg/ngyx7 ngy,
hoc Quinine (liu nh trn) phi hp vi Clindamycine ung 15mg/kg/ngy, chia 2 ln x 7 ngy (cho ph n c thai hoc
tr < 8 tui).
+ Primaquin 0,5mg/kg, NL 4 vien duy nhat diet giao bao,
SR do P.vivax, P.ovale hoac do P.malariae :
CHLOROQUINE: vien 250 mg[N1, N2= 4 vien (10mg/kg); N3 = 2 vien (5mg/kg) 10 vien]
PRIMAQUINE: vien 13,2mg (7,5 mg base) : 2 vien/ngay
[0,25 mg/kg x 14 ngay (CC: thai phu)]
Viem gan cap: TCLS ien hnh gi y viem gan (vang da, au hs (P),..):25%, thng ch gap the ien hnh, ko
giup phan biet nguyen nhan VG. a so bn ko co TC ro rang. C chu yeu da vao s tang cac men
transaminase.
Viem gan man: HC suy tb gan
co the ko co TC ro,ch co XN men gan bat thng keo dai
benh dien tien am tham, co the dan en bch x gan, K gan
co the co nhng t viem gan bung phat

C Viem gan: * nhom XN CN gan:

Men transaminase (ALT, AST, GGT): tieu chuan quan trong e VG
VG cap: co the tang > 1000 U/L, ALT > AST
X gan, VG do ru: AST > ALT
Ngoai ra, con roi loan: Bilirubin LDH ALPAlb, ien di protein CN ong mau sinh thiet gan
XN hnh anh hoc: SA, CT Scanner, MRI...
C nguyen nhan:
TK u benh: vai tuan vai thang Ko co TC ac biet
TK tien vang da: tb 1 tuan
met moi, an uong kem, au c, au khp, giong cam cum; sot nhe ko kem lanh run, au tc vung hs (P),tieu
vang
Tk vang da: vang da tang dan, nc tieu vang sam, buon non, non, ko dung nap chat m, sot giam hoac het
sot, met moi, suy nhc, gan to nhe, mem, au tc, co the co lach to hoac sao mach thoang qua
Vang da keo dai 2-6 tuan
TK hoi phuc: vang da giam dan, tieu nhieu, bn cam giac khoe hn oi khi met moi keo dai vai tuan en vai
thang

Viem phoi
St thng km lnh run, cp hoc bn cp
Ho khc m m, vng, xanh
Kh th, mt
au ngc: au ngc kiu mng phi
Triu chng khc: v m hi, chn n, nhc u, au
c
Khm thy:
Hi chng ng c
Ran n
m thi ng
C mng phi
CLS: Bch cu mu tng > 15 000/mm3( a nhn trung tnh) hoc gim nng <
3000/mm3
Nhum gram v soi cy m
Kh mu ng mch: gim oxy mu
X quang phi: thm nhim, ng c, trn dch mng phi
iu tr:BN an ung y / iu tr triu chng/ cn bng nc ing gii, th oxy/ tp vt l tr liu/ chn khng sinh thch
hp

1/Tiu chun chun on T? (khng - hc thm trong sch sinh l bnh)

Cn c 1 trong 4 tiu ch sau:
1-uong huyt lc i tnh mch 126 mg/dL x 2 ln
2-H bt k 200 mg/dL + tr/c tng ng huyt (tiu nhiu, kht, ung nhiu, st cn).
3-H 2 gi sau khi ung 75g glucose 200mg/dL.
4-HbA1c >=6.5% (XN phi chun theo NGSP v phng php ca nghin cu DCCT): tiu ch ny mi b sung trong ADA
2010
Trong trng hp khng c ri lon cp tnh, cn lp li tiu ch mt ln na.Tnh trng i: khng n 8 gi.