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7/24/2019 VCTC Y4moi
1/30
Vim cu thn cpsau nhim trng
Nguyn Th Qunh Hng -2!
7/24/2019 VCTC Y4moi
2/30
i cng
V"T" sau nhim trng # c$ %i&n'
V"T" () nhim trng (i *hu+n
Vim thn , shunt. Vim n/i t0m m1c. Nung m s0u 34$ th&45nh th6ng7. 8iang mai 3H"TH 4+m sinh7
V"T" () nhim *9 sinh trng :;t rt V8 " 3V"T t?ng sinh m)ng7. V8 @ 3V"T ng1i m)ng7. HAV
7/24/2019 VCTC Y4moi
3/30
TB CD mEc *hFng rG nhng rt thp c=c nIc ph=t tri&n
J K !2 tu$i. namLnM2
VCTCsau nhim trng
i cng
@Dnh C9 min ,ch huyOt thanh 3"A"7 nhng cPng h1t h= cn%6ng # aCtrn R ca 4$ th& 4Sng N Cin cu gEn gian m1ch
@i&u hiDn 4i tam chUng ph. ca HW () %=i m=u
7/24/2019 VCTC Y4moi
4/30
Nhim trng TMH (7 ti 15 ngy) hoc da (3 ti 6 tun)
o !i"n cu #$ta tan huy%t nh&m ' gy raThnh *+ ny c& ,rot$in T - M
.rot$in M/ ty,$ 1, 2, 4, 12, 18, 25 (nhim trng hng)
02 552 572 - 6 (nhim trng da) 4c #it gy -i"m thn
VCTCsau nhim trng
i cng
7/24/2019 VCTC Y4moi
5/30
" chO 4Dnh sinh Nhim khun
P KN-KT
Vim ma m!"h Vim ma m!"h "#u th$n
T%ng t&nh th'm " m!"h " m!"h "#u th$n Vim u't ti*t
+ Na n./" t%ng 0" "n thi*u m3u "" t%ng t&nh th'm gim i6n 7" gian ng!i in 9 th$n mng :3;
T%ng ti*t r, Pr ni6u t%ng ?" "#u th$n gim
Ph :3i &t @r< t%ng
Au; tim "'B =Cn m, " gi$t 0u; th$n "'B
7/24/2019 VCTC Y4moi
6/30
@i&u hiDn C0m s)ng
Tam chUng (im thn
Xh th6ng chY ,in 4iOn trng Z-! ng)y
HW tr ([ 45nh th6ng sau 2-\ tun
]=i m=u %1i th& trng !-\ tun^ Vi th& c_ th& *
7/24/2019 VCTC Y4moi
7/30
XN CLS
H niu - .rot$in niu
8ur" - cr9atinin$ m:u
H5 - 3 gi;m
' ngy - ngy 1 ?nh ,h@m hAng n%u c& B nhim trng tiCm tng
7/24/2019 VCTC Y4moi
8/30
@i&u hiDn cn C0m s)ng
"\ tr ([ 45nh th6ng sau `- tun
Xrtin niDu c_ th& 4iOn mt trng 2-\ th=ng^
Thm chd Xrtin niDu t thO !-2 n?m sau^
NOu Xe () H" niDu *
7/24/2019 VCTC Y4moi
9/30
"=c th& C0m s)ng
ThD thCng th.Eng thD "a hu;*t 3B
thD :3i m3u thD 0u; th$n V>T> ti*n triDn nhanh
V>T> thD k*t hFB V>T 3n "'B
7/24/2019 VCTC Y4moi
10/30
+hi no thD nh, -in
TEng H'
7/24/2019 VCTC Y4moi
11/30
.hn thF #nh
>G gH khG kh%n I BhJn thD 7Jm0ng
PhJn thD gii BhLu 6nh
7/24/2019 VCTC Y4moi
12/30LGM
$ndoca,i!!air$ $Gtraca,i!!air$N9i m!"h Ng!i m!"h>M" m!"h
TiDu O :i
TiDu O :*nTr" gian m!"h
Khang n./" tiDua Qman
T iDu mC
Rng 7.Fn g#n
>#u th$n Hnh th.Eng
7/24/2019 VCTC Y4moi
13/30
TEng inh nIi mJch
7/24/2019 VCTC Y4moi
14/30
*T tEng inh nIi mJch !an to;
St :#u :9t ng9t /i :3i m3u hUng:nh (:!i thD hW" i thD)X
Prt
7/24/2019 VCTC Y4moi
15/30
TEng inh nIi ngoJi mJch !an to;
7/24/2019 VCTC Y4moi
16/30
TEng inh ngoJi mJch
7/24/2019 VCTC Y4moi
17/30
*T tEng inh nIi ngoJi mJch
VCT tng sinh : T%ng 0inh t/i \]-8]^ "#u th$n trn tiu
n ( t%ng 0inh _\]-5]^ ti*n triDn thu$n
7Fi, `5]^ thH t%ng = 0u; th$n 0aunhiIu n%m ti*n triDn)X
T>?A th.Eng C ni6u nhiIu ng; 3i m3u kb i trn c th3ng Prt
7/24/2019 VCTC Y4moi
18/30
*T tEng inh nIi ngoJi mJch
d thD gim hUng :nh 0/m nga;khi St :#u 6nh
i*n "hng "ea :ng muZi n./"> gi$t ( Bhu nf), 0u; tim /iBh Bhdi "'B
!ng khCng :iDn hHnh /i :3i m3u
i thD
7/24/2019 VCTC Y4moi
19/30
*T tEng inh nIi ngoJi mJch
VCT tng sinh lan to: T%ng 0inh trn 8]^ "#u th$n trn
tiu n T>?A PrtT= tnt!i, t%ng =, 0u; th$n nga; khi St:#u hW" 0au i tu#n, ti*n triDn
#n :*n 0u; th$n giai :!n "uZi
VCTC th v niu, VCTC th cao HA, VCTC th kthp
7/24/2019 VCTC Y4moi
20/30
TEng inh mng
7/24/2019 VCTC Y4moi
21/30
*T tEng inh mng
T>?A =>T=
3i m3u hUng :nh T%ng = Au; th$n
Tin 7.Fng th.Eng 'u
VCTC th kt hp, VCTC th bn c!p, VCTC tin t"in nhanh
7/24/2019 VCTC Y4moi
22/30
TEng inh mng
7/24/2019 VCTC Y4moi
23/30
h@n 4o:n ,hn #it
#nh #$%&$% WB j-1\ tudi, th.Eng tr trai 3i m3u t3i Bh3t, :Ci khi khi Bh3t i
'u hi6u nhim trngX 3i m3u lY- Brt
7/24/2019 VCTC Y4moi
24/30
h@n 4o:n ,hn #it
HC Alpo"t: Tdn th.ng th$n tai o; ra nam, th.Eng "h*t :9 tudi 15-
\] H 0u; th$nX Np 7nh t&nh/i :3i m3u ithD, T 7Wn, 7in k*t o 3i m3u "G thD hi6n nga; khi : 3i m3u :!i thD "G thD gWB, :3i m3u i
thD tn t!i Prt\ Hnh th.Eng i*"
7/24/2019 VCTC Y4moi
25/30
h@n 4o:n ,hn #it
'i (u gia )*nh l+nh tnh: T tr9i, NAT th.Eng
3i m3u :n :9" Ainh thi*t th$n mng :3; mqngXCc ngu-.n nh/n khc:@, 0qi,
!ng, thuZ" nans
7/24/2019 VCTC Y4moi
26/30
Ch nh sinh thit thn
Lc bt !u b"nh# $nh gi$ % n&ng c'a b"nh (T)ng sinh ng*imch+
K *L niu ngy
K
7/24/2019 VCTC Y4moi
27/30
$i1i -h2u b"nh
Vi th3 *T tEng inh nIi mJch ( t% #o gian mJch - nIi mL)
ti%t (?SN trung tUnh)2 4Li Rhi tEng inh ngoJi mJch =Vng 4Ang RhLng 4Cu -i c:c RhWi Xuay ra ,hUa ngoicYa mng 4:y cu thn
T b/* h4c =Vng 4Ang RhLng 4Cu 3 ZP[ \g
7/24/2019 VCTC Y4moi
28/30
i5u tr
Tri"u ch6ng HJn ch% muWi n]c =^i tiFu SiCu tr_ tEng H' n%u c& (ch`n R"nh anGi) =Ac m:u
&c hi"u =oJi # B nhim trng tiCm tng
TMH2 rEng2 daSiCu tr_ ,$niGi!in2 dng !u di n%u c& B nhim trng
tbn tJiSiCu tr_ corticoid2 h$,arin2 t:ch huy%t t]ngtrong c:c
dJng nng
SiCu tr_ -i tun 4%n -i th:ng
7/24/2019 VCTC Y4moi
29/30
Tin tri3n
+hi trong 5 tr]Qng h^,
Ti"n !]^ng Geu f ng]Qi !n Nhim trng da Nng ngay Rhi #Vt 4u
TEng inh ngoJi mJch
7/24/2019 VCTC Y4moi
30/30
Tin tri3n th7ng th8ng
.h - thiFu niu/ -i ngy
TEng H' -i ngy 4%n 3 tun
S:i m:u 4Ji thF 1 th:ng S:i m:u -i thF 1[1 th:ng
.rot$in niu -i tun 4%n -i th:ng (Rho;ng 6 th:ng)
?B thF #Dnh th]Qng 6[ tun