Tieu phan den, set, kham: co 3 y nghia
- 90% XHTH tren
- luong mau it 50-200ml
- XHTH tren 6 gio: Hct phan anh dung tinh trang mat mau
Tien su lien quan loet dd-tt: 4 yeu to
- Uong ruou: 80% nguoi tre
- thuoc giam dau: 50% bn lon tuoi
- an uong ko dieu do
- stress trong gia dinh
Chan doan phan biet XHTH: 2 ve
- XHTH tren vs duoi
- Nguyen nhan:
• Loet dd-tt
• Viem da day xuat huyet (uong ruou nhieu)
• vo gian TM thuc quan
Nguyen tac dieu tri XHTH:
- Danh gia muc do mat mau: nhe, vua, nang
- Thiet lap duong truyen
- Nhin an hoan toan, ngung tat ca thuoc vien
- Han che di chuyen: tieu tieu tai giuong, ko ngoi day
Neu lam tot 4 nguyen tac tren 80% XHTH tu cam.
Neu benh on, 48g sau co the uong sua nguoi; 72g sau co the an chao.
Neu BN mat mau muc do nang
- Nam dau thap
- Tho oxy
- Dat sonde da day, sonde tieu
- Truyen mau 1/3 mau, 2/3 dich: 500ml mau, 1000 NaCl
CCD dat sone da day trong vo gian TM thuc quan.
Muc tieu truyen mau:
- Viet Nam: Hct >20% (tre) - 25% (gia)
- Nuoc ngoai: Hct >25% (tre) - 30% (gia)
Dung PPI:
- Omeprazole 80mg bolus, 40 mg/12g trong 72 gio (nguy to tai XH thap)
- Omeprazole 80mg bolus, 8 mg/g trong 72 gio (nguy co tai XH cao)
Nitrates hien tai da chung minh khong co tac dung trong giam ap luc tinh mach co, nen ko con dung phoi hop nua.
Khang sinh. dung trong vo gian tinh mach thuc quan co 3 muc dich
• ngua nhiem trung vi tri vo dan TM
• ngua tai phat xuat huyet
• giam ti le ty vong
KS duoc khuyen cao trong vo dan TM TQ la Ceftriaxone 1g.
Nhuan trang. Cho nhung BN XHTH de tong xuat luong mau con trong long ruot cang som cang tot, neu ko co nguy co tao NH3 gay hon me gan. Dung Lactulose la tot nhat.