{"id":13730,"date":"2026-02-03T08:51:36","date_gmt":"2026-02-03T01:51:36","guid":{"rendered":"https:\/\/bvndgiadinh.org.vn\/?p=13730"},"modified":"2026-02-24T08:51:45","modified_gmt":"2026-02-24T01:51:45","slug":"benh-vien-nhan-dan-gia-dinh-trien-khai-ung-dung-sieu-am-do-the-tich-da-day-truoc-gay-me-them-mot-lop-an-toan-va-nen-tang-de-trien-khai-eras-manh-me-hon","status":"publish","type":"post","link":"https:\/\/bvndgiadinh.org.vn\/?p=13730","title":{"rendered":"B\u1ec6NH VI\u1ec6N NH\u00c2N D\u00c2N GIA \u0110\u1ecaNH: TRI\u1ec2N KHAI \u1ee8NG D\u1ee4NG SI\u00caU \u00c2M \u0110O TH\u1ec2 T\u00cdCH D\u1ea0 D\u00c0Y TR\u01af\u1edaC G\u00c2Y M\u00ca – TH\u00caM M\u1ed8T \u201cL\u1edaP AN TO\u00c0N\u201d V\u00c0 N\u1ec0N T\u1ea2NG \u0110\u1ec2 TRI\u1ec2N KHAI ERAS M\u1ea0NH M\u1ebc H\u01a0N"},"content":{"rendered":"\n

BS CKII Hu\u1ef3nh V\u0103n B\u00ecnh Khoa G\u00e2y m\u00ea h\u1ed3i s\u1ee9c B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh<\/em><\/strong><\/p>\n\n\n\n

Trong g\u00e2y m\u00ea h\u1ed3i s\u1ee9c, m\u1ed9t trong nh\u1eefng bi\u1ebfn c\u1ed1 nghi\u00eam tr\u1ecdng nh\u1ea5t l\u00e0 h\u00edt s\u1eb7c d\u1ecbch d\u1ea1 d\u00e0y trong qu\u00e1 tr\u00ecnh kh\u1edfi m\u00ea\/\u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u00eam ph\u1ed5i h\u00edt, suy h\u00f4 h\u1ea5p v\u00e0 l\u00e0m n\u1eb7ng th\u00eam ti\u00ean l\u01b0\u1ee3ng sau m\u1ed5. V\u00ec v\u1eady, ki\u1ec3m so\u00e1t \u201cd\u1ea1 d\u00e0y c\u00f3 th\u1ef1c s\u1ef1 tr\u1ed1ng hay kh\u00f4ng\u201d l\u00e0 y\u1ebfu t\u1ed1 then ch\u1ed1t \u0111\u1ec3 n\u00e2ng chu\u1ea9n an to\u00e0n g\u00e2y m\u00ea, \u0111\u1eb7c bi\u1ec7t trong b\u1ed1i c\u1ea3nh ng\u00e0y c\u00e0ng nhi\u1ec1u ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 ch\u1eadm l\u00e0m tr\u1ed1ng d\u1ea1 d\u00e0y d\u00f9 \u0111\u00e3 nh\u1ecbn \u0103n \u0111\u00fang h\u01b0\u1edbng d\u1eabn. <\/p>\n\n\n

\n
\"\"<\/figure><\/div>\n\n\n

T\u1eeb th\u1ef1c ti\u1ec5n \u0111\u00f3, B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh \u0111\u00e3 nghi\u00ean c\u1ee9u v\u00e0 tri\u1ec3n khai k\u1ef9 thu\u1eadt si\u00eau \u00e2m \u0111o th\u1ec3 t\u00edch d\u1ea1 d\u00e0y \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed3n l\u01b0u tr\u01b0\u1edbc ph\u1eabu thu\u1eadt. \u0110\u00e2y l\u00e0 k\u1ef9 thu\u1eadt kh\u00f4ng x\u00e2m l\u1ea5n, c\u01a1 \u0111\u1ed9ng, th\u1ef1c hi\u1ec7n ngay t\u1ea1i gi\u01b0\u1eddng\/ph\u00f2ng m\u1ed5, gi\u00fap b\u00e1c s\u0129 g\u00e2y m\u00ea h\u1ed3i s\u1ee9c c\u00f3 th\u00eam d\u1eef li\u1ec7u kh\u00e1ch quan \u0111\u1ec3 ra quy\u1ebft \u0111\u1ecbnh tr\u01b0\u1edbc khi g\u00e2y m\u00ea, thay v\u00ec ch\u1ec9 d\u1ef1a v\u00e0o th\u1eddi gian nh\u1ecbn \u0103n. Gi\u00e1 tr\u1ecb c\u1ee7a si\u00eau \u00e2m d\u1ea1 d\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn v\u1edbi \u0111\u1ed9 nh\u1ea1y cao (91\u2013 100%) v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u (71\u201397,5%) tu\u1ef3 nghi\u00ean c\u1ee9u. <\/p>\n\n\n\n

\u0110i\u1ec3m \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng l\u00e0: k\u1ef9 thu\u1eadt n\u00e0y kh\u00f4ng ch\u1ec9 t\u0103ng an to\u00e0n g\u00e2y m\u00ea theo ngh\u0129a truy\u1ec1n th\u1ed1ng, m\u00e0 c\u00f2n tr\u1edf th\u00e0nh n\u1ec1n t\u1ea3ng an to\u00e0n \u0111\u1ec3 b\u1ec7nh vi\u1ec7n tri\u1ec3n khai chi\u1ebfn l\u01b0\u1ee3c ERAS, trong \u0111\u00f3 c\u00f3 u\u1ed1ng carbohydrate tr\u01b0\u1edbc ph\u1eabu thu\u1eadt nh\u1eb1m gi\u1ea3m kh\u00f3 ch\u1ecbu tr\u01b0\u1edbc m\u1ed5, gi\u1ea3m \u0111\u00e1p \u1ee9ng stress, h\u1ed7 tr\u1ee3 ph\u1ee5c h\u1ed3i s\u1edbm sau m\u1ed5. ERAS c\u1ea7n \u201c\u0111\u1ea9y nhanh h\u1ed3i ph\u1ee5c\u201d, nh\u01b0ng b\u1eaft bu\u1ed9c \u201ckh\u00f4ng \u0111\u00e1nh \u0111\u1ed5i an to\u00e0n\u201d; v\u00e0 si\u00eau \u00e2m d\u1ea1 d\u00e0y ch\u00ednh l\u00e0 c\u00f4ng c\u1ee5 gi\u00fap b\u1ec7nh vi\u1ec7n l\u00e0m \u0111\u01b0\u1ee3c c\u1ea3 hai theo h\u01b0\u1edbng c\u00e1 th\u1ec3 ho\u00e1. <\/p>\n\n\n\n

V\u1ec1 ch\u1ec9 \u0111\u1ecbnh, b\u1ec7nh vi\u1ec7n \u01b0u ti\u00ean si\u00eau \u00e2m d\u1ea1 d\u00e0y cho ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 d\u1ea1 d\u00e0y \u0111\u1ea7y ho\u1eb7c nghi ng\u1edd d\u1ea1 d\u00e0y \u0111\u1ea7y, \u0111i\u1ec3n h\u00ecnh nh\u01b0: ch\u1eadm l\u00e0m tr\u1ed1ng d\u1ea1 d\u00e0y do chuy\u1ec3n ho\u00e1 (\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ki\u1ec3m so\u00e1t k\u00e9m), suy th\u1eadn, nhi\u1ec5m khu\u1ea9n huy\u1ebft; gi\u1ea3m nhu \u0111\u1ed9ng (ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o); b\u1ec7nh l\u00fd d\u1ea1 d\u00e0y\u2013m\u00f4n v\u1ecb, tr\u00e0o ng\u01b0\u1ee3c; t\u0103ng \u00e1p l\u1ef1c \u1ed5 b\u1ee5ng (mang thai, b\u00e9o ph\u00ec); d\u00f9ng opioid; ch\u1ea5n th\u01b0\u01a1ng; nh\u1ecbn \u0103n\/u\u1ed1ng ch\u01b0a \u0111\u1ee7 ho\u1eb7c tr\u01b0\u1eddng h\u1ee3p ph\u1eabu thu\u1eadt c\u1ea5p c\u1ee9u kh\u00f4ng t\u1ed1i kh\u1ea9n. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh quan tr\u1ecdng l\u00e0 ti\u1ec1n c\u0103n ph\u1eabu thu\u1eadt d\u1ea1 d\u00e0y. <\/p>\n\n\n\n

Quy tr\u00ecnh tri\u1ec3n khai \u0111\u01b0\u1ee3c chu\u1ea9n ho\u00e1 ch\u1eb7t ch\u1ebd: th\u1ef1c hi\u1ec7n t\u1ea1i ph\u00f2ng m\u1ed5\/Khoa G\u00e2y m\u00ea H\u1ed3i s\u1ee9c, th\u1eddi gian kho\u1ea3ng 30 ph\u00fat, do 01 b\u00e1c s\u0129 g\u00e2y m\u00ea h\u1ed3i s\u1ee9c \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o si\u00eau \u00e2m c\u01a1 b\u1ea3n v\u00e0 si\u00eau \u00e2m d\u1ea1 d\u00e0y c\u00f9ng 01 \u0111i\u1ec1u d\u01b0\u1ee1ng ph\u1ee5, s\u1eed d\u1ee5ng m\u00e1y si\u00eau \u00e2m v\u1edbi \u0111\u1ea7u d\u00f2 convex. Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn tr\u01b0\u1edbc th\u1ee7 thu\u1eadt, ki\u1ec3m tra h\u1ed3 s\u01a1 \u2013 nh\u1eadn di\u1ec7n \u0111\u00fang ng\u01b0\u1eddi b\u1ec7nh \u2013 v\u00e0 th\u1ef1c hi\u1ec7n b\u1ea3ng ki\u1ec3m an to\u00e0n theo quy \u0111\u1ecbnh. <\/p>\n\n\n

\n
\"\"<\/figure><\/div>\n\n\n

V\u1ec1 k\u1ef9 thu\u1eadt, b\u00e1c s\u0129 kh\u1ea3o s\u00e1t hang v\u1ecb d\u1ea1 d\u00e0y \u1edf t\u01b0 th\u1ebf chu\u1ea9n (th\u01b0\u1eddng l\u00e0 n\u1eb1m nghi\u00eang ph\u1ea3i, \u0111\u1ea7u cao 30\u201345\u00b0) \u0111\u1ec3 t\u1ed1i \u01b0u \u0111\u00e1nh gi\u00e1. Sau khi x\u00e1c \u0111\u1ecbnh m\u1eb7t c\u1eaft ph\u00f9 h\u1ee3p, b\u00e1c s\u0129 \u0111o c\u00e1c \u0111\u01b0\u1eddng k\u00ednh c\u1ee7a hang v\u1ecb v\u00e0 t\u00ednh di\u1ec7n t\u00edch hang v\u1ecb (CSA) theo c\u00f4ng th\u1ee9c, t\u1eeb \u0111\u00f3 \u01b0\u1edbc t\u00ednh th\u1ec3 t\u00edch d\u1ea1 d\u00e0y (GV) theo m\u00f4 h\u00ecnh chu\u1ea9n ho\u00e1 (c\u00f3 hi\u1ec7u ch\u1ec9nh theo tu\u1ed5i).<\/p>\n\n\n\n

\u0110i\u1ec1u l\u00e0m n\u00ean \u201cgi\u00e1 tr\u1ecb ra quy\u1ebft \u0111\u1ecbnh\u201d c\u1ee7a k\u1ef9 thu\u1eadt l\u00e0 b\u1ec7nh vi\u1ec7n \u0111\u00e3 quy \u0111\u1ecbnh r\u00f5 ti\u00eau chu\u1ea9n nh\u1eadn di\u1ec7n d\u1ea1 d\u00e0y \u0111\u1ea7y \u2013 t\u1ee9c nguy c\u01a1 h\u00edt s\u1eb7c cao h\u01a1n \u2013 khi c\u00f3 m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u: ph\u00e1t hi\u1ec7n th\u1ee9c \u0103n \u0111\u1eb7c \u1edf b\u1ea5t k\u1ef3 t\u01b0 th\u1ebf; ho\u1eb7c th\u1ec3 t\u00edch d\u1ea1 d\u00e0y \u1edf t\u01b0 th\u1ebf nghi\u00eang ph\u1ea3i > 1,5 mL\/kg; ho\u1eb7c trong tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda th\u00ec CSA > 3,40 cm\u00b2. Nh\u1edd c\u00e1c ng\u01b0\u1ee1ng r\u00f5 r\u00e0ng n\u00e0y, \u00ea-k\u00edp g\u00e2y m\u00ea c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn chi\u1ebfn l\u01b0\u1ee3c ph\u00f9 h\u1ee3p cho t\u1eebng ng\u01b0\u1eddi b\u1ec7nh ngay tr\u01b0\u1edbc cu\u1ed9c m\u1ed5, v\u00e0 ghi nh\u1eadn k\u1ebft qu\u1ea3 v\u00e0o h\u1ed3 s\u01a1 b\u1ec7nh \u00e1n \u0111\u1ec3 t\u0103ng t\u00ednh minh b\u1ea1ch, truy xu\u1ea5t v\u00e0 c\u1ea3i ti\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng li\u00ean t\u1ee5c. <\/p>\n\n\n\n

Tr\u00ean n\u1ec1n t\u1ea3ng \u0111\u00f3, khi tri\u1ec3n khai ERAS, \u0111\u1eb7c bi\u1ec7t l\u00e0 u\u1ed1ng carbohydrate tr\u01b0\u1edbc ph\u1eabu thu\u1eadt, b\u1ec7nh vi\u1ec7n c\u00f3 th\u1ec3 \u0111i theo h\u01b0\u1edbng v\u1eeba ch\u1ee7 \u0111\u1ed9ng v\u1eeba th\u1eadn tr\u1ecdng: \u0111a s\u1ed1 ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n s\u1ebd \u0111\u01b0\u1ee3c h\u01b0\u1edfng l\u1ee3i \u00edch h\u1ed3i ph\u1ee5c s\u1edbm; c\u00f2n nh\u00f3m nguy c\u01a1 ch\u1eadm l\u00e0m tr\u1ed1ng d\u1ea1 d\u00e0y s\u1ebd \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 kh\u00e1ch quan b\u1eb1ng si\u00eau \u00e2m \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh c\u00e1 th\u1ec3 ho\u00e1, nh\u1eb1m gi\u1eef v\u1eefng chu\u1ea9n an to\u00e0n \u0111\u01b0\u1eddng th\u1edf trong g\u00e2y m\u00ea. N\u00f3i c\u00e1ch kh\u00e1c, carbohydrate l\u00e0 \u201c\u0111\u1ed9ng l\u1ef1c h\u1ed3i ph\u1ee5c\u201d c\u1ee7a ERAS, c\u00f2n si\u00eau \u00e2m d\u1ea1 d\u00e0y l\u00e0 \u201cvan an to\u00e0n\u201d c\u1ee7a g\u00e2y m\u00ea hi\u1ec7n \u0111\u1ea1i. <\/p>\n\n\n\n

Vi\u1ec7c \u0111\u01b0a si\u00eau \u00e2m d\u1ea1 d\u00e0y v\u00e0o th\u1ef1c h\u00e0nh th\u01b0\u1eddng quy th\u1ec3 hi\u1ec7n r\u00f5 \u0111\u1ecbnh h\u01b0\u1edbng c\u1ee7a B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh: \u0111\u1ea7u t\u01b0 c\u00f4ng ngh\u1ec7 \u0111\u00fang tr\u1ecdng \u0111i\u1ec3m, chu\u1ea9n ho\u00e1 quy tr\u00ecnh, \u0111\u00e0o t\u1ea1o nh\u00e2n l\u1ef1c v\u00e0 l\u1ea5y an to\u00e0n ng\u01b0\u1eddi b\u1ec7nh l\u00e0m trung t\u00e2m, \u0111\u1ed3ng th\u1eddi t\u1ea1o n\u1ec1n t\u1ea3ng \u0111\u1ec3 tri\u1ec3n khai ERAS b\u00e0i b\u1ea3n, nh\u1ea5t qu\u00e1n v\u00e0 hi\u1ec7u qu\u1ea3 h\u01a1n trong m\u1ee5c ti\u00eau chung: ph\u1eabu thu\u1eadt an to\u00e0n h\u01a1n \u2013 \u00edt bi\u1ebfn ch\u1ee9ng h\u01a1n \u2013 h\u1ed3i ph\u1ee5c nhanh h\u01a1n. <\/p>\n\n\n\n

T\u00e0i li\u1ec7u tham kh\u1ea3o <\/strong><\/p>\n\n\n\n

1. L\u00fd Huy\u1ec3n Ho\u00e0, Nguy\u1ec5n Th\u1ecb Qu\u00fd. \u0110\u00e1nh gi\u00e1 th\u1ec3 t\u00edch t\u1ed3n l\u01b0u d\u1ea1 d\u00e0y c\u1ee7a dung d\u1ecbch maltodextrine u\u1ed1ng 2 gi\u1edd tr\u01b0\u1edbc g\u00e2y m\u00ea. T\u1ea1p ch\u00ed Y h\u1ecdc Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh 2020;24(3):76-82. <\/p>\n\n\n\n

2. \u0110\u1ed7 Nguy\u1ec5n Tr\u1ecdng Nh\u00e2n, Nguy\u1ec5n Th\u1ecb Thanh. \u0110\u00e1nh gi\u00e1 th\u1ec3 t\u00edch t\u1ed3n l\u01b0u d\u1ea1 d\u00e0y c\u1ee7a dung d\u1ecbch maltodextrine 25% u\u1ed1ng 2 gi\u1edd tr\u01b0\u1edbc g\u00e2y m\u00ea. T\u1ea1p ch\u00ed Y h\u1ecdc Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh 2020;24(3):119-126 <\/p>\n\n\n\n

3. Phan Qu\u1ed1c Th\u00e1i, Doanh \u0110\u1ee9c Long, Ho\u00e0ng Qu\u1ed1c Th\u1eafng. Si\u00eau \u00e2m \u0111\u00e1nh gi\u00e1 th\u1ec3 t\u00edch d\u1ea1 d\u00e0y \u1edf ng\u01b0\u1eddi b\u1ec7nh ph\u1eabu thu\u1eadt ch\u1ea5n th\u01b0\u01a1ng c\u1ea5p c\u1ee9u. T\u1ea1p ch\u00ed Y h\u1ecdc Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh 2024;27(3):103-108 <\/p>\n\n\n\n

4. Nguy\u1ec5n Thanh T\u00e2n, Nguy\u1ec5n Th\u1ecb Ph\u01b0\u01a1ng Dung, Ho\u00e0ng Qu\u1ed1c Th\u1eafng. \u0110\u00e1nh gi\u00e1 th\u1ec3 t\u00edch t\u1ed3n l\u01b0u d\u1ea1 d\u00e0y \u1edf ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng sau u\u1ed1ng n\u01b0\u1edbc trong 2 gi\u1edd tr\u01b0\u1edbc m\u1ed5. T\u1ea1p ch\u00ed Y h\u1ecdc Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh 2025;28(3):88-94.<\/p>\n","protected":false},"excerpt":{"rendered":"

BS CKII Hu\u1ef3nh V\u0103n B\u00ecnh Khoa G\u00e2y m\u00ea h\u1ed3i s\u1ee9c B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh Trong g\u00e2y m\u00ea h\u1ed3i s\u1ee9c, m\u1ed9t trong nh\u1eefng bi\u1ebfn c\u1ed1 nghi\u00eam tr\u1ecdng nh\u1ea5t l\u00e0 h\u00edt s\u1eb7c d\u1ecbch d\u1ea1 d\u00e0y trong qu\u00e1 tr\u00ecnh kh\u1edfi m\u00ea\/\u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u00eam ph\u1ed5i h\u00edt, suy h\u00f4 h\u1ea5p v\u00e0 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