Bs. Ck2.

inh Quan Tm

Chy mu trong lng ng tiu ha do tn thng t thc qun, d dy, t trng n pha trn gc Treit.

Lot t trng: 24% Vim d dy cp: 20% Lot d dy: 15% Dn tnh mch thc qun: 14% Vim thc qun: 6% Hi chng Mallory_Weiss : 5% Cc nguyn nhn khc: 10% Khng xc nh: 6%

Nh

Trung bnh

Nng

Lng mu mt
Tri gic Mch Huyt p tm thu Hct S lng hng cu

< 500ml
Tnh, bnh thng < 90l/p > 90mmHg > 30% > 3triu

500-1000ml
nim hng nht, mt mi 90-120l/p 80 - 90mmHg 20 - 30% 2 - 3 triu

> 1000ml
Bt rt, ht hong, vt v > 120l/p < 80mmHg < 20% < 2triu

n nh bnh nhn. Xc inh v tr, nguyn nhn xut huyt. nh gi mc nng. X tr cp cu iu tr bin chng, nh gi nguy c xut huyt ti pht.

Tip xc BN

Xc nh c XHTH: i mu, tiu phn en, tiu mu.. nh gi mc : nh, trung bnh, nng.

X tr ban u

Lp ng truyn: 1-2 ng truyn, CVP t sonde mi d dy

Ni soi chn on v iu tr Cc thuc: Antacid, c ch bm Proton, Octreotide

iu tr

 iu tr ni khoa: Thuc khng th th H2. Thuc c ch bm proton. Ni soi chn on v iu tr: nh gi tnh trng chy mu. Phng php cm mu:
Chch Adrenaline, Polidocanol 1 -2%, Absolute Ethanol Laser YAG, ng mu bng vi sng, t nhit. Kp mch mu (Clip).

iu tr ngoi khoa: Khu cm mu lot, m rng mn v km ct DTK X. Ct bn phn d dy.

 Tn bit dc: Nexium, Esomarks,... 40mg/l Cch dng:

Tn cng:
Bolus TM: 80mg (2 ng). TTM: 8mg/1h/72h pha 5 ng vo NaCl 9%0 thnh 25ml, bm tim in 1ml/gi.

Duy tr:
Vin 40mg, 1 vin/ln/ngy/ 27 ngy.

 ang chy mu
I a chy mu phun thnh vi I b chy mu r r II a thy mch mu II b cn cc mu ng II c c chm khc mu

Chy mu gn y

Khng c chy mu
III khng thy du hiu chy mu

 Ni soi: chch x, tht dy thun, t stent Thuc co mch. t sonde Blakemore. Phu thut trit mch Sugiura, PT to Shunt.

 Tc dng: + Gim lng mu h tng 25% + Gim lng mu n gan 25% + Gim p lc trn gan bt 10-15% + Gim p lc trong tnh mch thc qun trng 35% + Thuc khng lm thay i mch, huyt p v cung lng tim. Bit dc: Sandostatin ... 0,1 mg/1ml/ng Cch dng: Tim TM: 0,1 mg. TTM: 0,025/gi/5 ngy. Pha 06 ng vo NaCl9%o thnh 24 ml, bm tim in 1ml/gi.

Loi A (Nguy c thp) Bng bng 0

Loi B Loi C (nguy c trung bnh) (Nguy c cao) Nh Nhiu

Hn m gan
Albumin/mu(mg%) Dinh dng T vong

0
>3.5 Tt 5_10%

1_2
3_3.5 2_3 Trung bnh 15_25%

3_4
<3.5 >3 Xu, suy kit 50_70%

Bilirubin/mu (mg%) <2

 Xc nh chiu di: cnh mi di tai (T) hm c + 10 cm Bm bng: bng DD 50ml + 150 bng TQ 60ml Ko cng:

 Mi 30p bm ra d dy xem cn chy khng. Cn : bm bng DD 250ml. Sau vn chy bm thm bng TQ 70 ml Ngy u, mi 6h x ht hi trong bng thc qun 30ml nhng vn gi ng thng ti ch: Nu chy mu li: bm bng thc qun nh lc u. Nu khng chy mu: thm 24h m khng chy th x bng d dy, rt ng thng. Nu qua ngy 2: mi 4h x bng thc qun 30ml

 Khi xut huyt mc nng: 1/3 khi lng tun hon l mu. 2/3 khi lng tun hon l dd ng trng Truyn n khi tri gic, mch, HA n nh, Hct>20%,HC>2triu. Khi cha c mu kp thi thay bng Genlafudin.

Thng s T vong chung Theo tui > 60 > 80 Huyt p tm thu lc vo vin 80 - 90mmHg < 80mmHg Dch ra thng d dy lc vo vin Nh b c ph Mu ti Truyn mu > 10 n v (1 n v =500ml)

T vong (%) 5-8 10 - 15 25 - 30

12 - 15 30 - 35
6 - 10 18 - 20 28 - 34