Tinh trang gan anh huong den su an toan cua cat co duong ruou nhu the nao

Cat co duong ruou la mot thu tuc y te – khong chi don gian la “cho doi” nhung ngay kho khan. Su an toan cua no phu thuoc vao nhieu bien so va tinh trang gan la mot trong nhung bien so quan trong nhat. Gan chuyen hoa hau het cac thuoc duoc su dung trong qua trinh cat co, san xuat cac yeu to dong mau va albumin, dieu hoa can bang noi moi glucose va loai bo doc to – bao gom ammoniac, tich luy voi gan bi ton thuong dan den benh nao. Bo qua tinh trang gan khi lap ke hoach cat co ruou la mot sai lam lam sang nghiem trong.

Gan o trung tam duoc ly cat co

Dieu tri tieu chuan hoi chung cat nguon ruou dua tren benzodiazepin – cac chat dieu bien the thu the GABA-A va uc che kich dong qua muc cua he than kinh. Van de la tat ca benzodiazepin deu duoc chuyen hoa boi gan – theo mot cach phu thuoc cao vao tinh trang cua no.

Diazepam va clordiazepoxide duoc chuyen hoa boi enzym cytochrome P450 thanh cac chuyen hoa hoat tinh voi thoi gian ban huy loai tru 36-200 gio. O benh nhan xo gan, su loai tru giam drastically. O lieu tieu chuan co the xay ra tich luy thuoc voi an than qua muc va trong cac truong hop cuc doan la uc che ho hap.

Do do cac huong dan lam sang khuyen ca o benh nhan xo gan su dung benzodiazepin tac dung ngan khong co chuyen hoa hoat tinh: lorazepam hoac oxazepam. Lorazepam duoc chuyen hoa bang lien hop glucuronide – con duong tuong doi duoc bao ton ngay ca trong benh gan tien trien.

Danh gia chuc nang gan truoc cat co

Diem Child-Pugh va MELD la cong cu danh gia rui ro

Diem Child-Pugh gom nam tham so: bilirubin, albumin, INR, muc do benh nao va co truong. Loai A (5-6 diem), B (7-9), C (10-15). Benh nhan loai C can theo doi cap benh vien trong cat co.

Diem MELD dua tren bilirubin, INR va creatinine. MELD tren 20 lien quan den ti le tu vong ngan han cao va la chi dinh dieu tri gan tich cuc.

Benh nao gan va me sang cat ruou – phan biet quan trong

Cat co nen thuc hien o dau theo giai doan benh gan

Cau hoi thuong gap

Tai lieu tham khao

1. Mayo-Smith MF. Pharmacological management of alcohol withdrawal. JAMA. 1997;278(2):144-151.
2. Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464-470.
3. European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines: Alcohol-related liver disease. J Hepatol. 2018;69(1):154-181.
4. Wijdicks EF. Hepatic encephalopathy. N Engl J Med. 2016;375(17):1660-1670.