{"id":273922,"date":"2009-02-10T01:00:00","date_gmt":"2009-02-09T18:00:00","guid":{"rendered":"https:\/\/clients-previewhub.com\/hoanmy_wp\/xu-ly-cac-bien-chung-tieu-hoa-o-benh-nhan-dai-thao-duong\/"},"modified":"2025-11-08T19:22:04","modified_gmt":"2025-11-08T12:22:04","slug":"xu-ly-cac-bien-chung-tieu-hoa-o-benh-nhan-dai-thao-duong","status":"publish","type":"post","link":"https:\/\/clients-previewhub.com\/hoanmy_wp\/xu-ly-cac-bien-chung-tieu-hoa-o-benh-nhan-dai-thao-duong\/","title":{"rendered":"X\u1eed L\u00fd C\u00e1c Bi\u1ebfn Ch\u1ee9ng Ti\u00eau Ho\u00e1 \u1edf B\u1ec7nh Nh\u00e2n \u0110\u00e1i Th\u00e1o \u0110\u01b0\u1eddng"},"content":{"rendered":"\n\n\n
<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

– C\u1ea7n gi\u1ea3m c\u00e1c ch\u1ea5t b\u00e9o v\u00ec ch\u00fang c\u00f3 khuynh h\u01b0\u1edbng k\u00e9o d\u00e0i vi\u1ec7c l\u00e0m r\u1ed7ng d\u1ea1 d\u00e0y.<\/p>\n

– C\u00f3 th\u1ec3 d\u00f9ng th\u00eam metoclopramide<\/strong> 10 mg t\u1eeb 2 \u0111\u1ebfn 4 l\u1ea7n m\u1ed7i ng\u00e0y, n\u1ebfu c\u1ea7n thi\u1ebft.<\/p>\n

Tuy nhi\u00ean thu\u1ed1c s\u1ebd kh\u00f4ng \u0111\u01b0\u1ee3c h\u1ea5p thu t\u1ed1t n\u1ebfu c\u00f2n nhi\u1ec1u th\u1ee9c \u0103n t\u1ed3n d\u01b0 do li\u1ec7t d\u1ea1 d\u00e0y. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u1ea7n h\u00fat d\u1ecbch d\u1ea1 d\u00e0y, nu\u00f4i \u0103n b\u1eb1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, d\u00f9ng thu\u1ed1c qua \u0111\u01b0\u1eddng ti\u00eam truy\u1ec1n cho \u0111\u1ebfn khi d\u1ea1 d\u00e0y b\u1eaft \u0111\u1ea7u ho\u1ea1t \u0111\u1ed9ng tr\u1edf l\u1ea1i v\u00e0 c\u00f3 th\u1ec3 chuy\u1ec3n sang thu\u1ed1c u\u1ed1ng.<\/p>\n

– C\u00e1c thu\u1ed1c kh\u00e1c nh\u01b0 thu\u1ed1c ch\u1ee7 v\u1eadn cholinergic (cholinergic agonist) bethanechol<\/strong> v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf cholinesterase pyridostigmine<\/strong> c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn, nh\u01b0ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng th\u1ea5p l\u1ea1i hay g\u00e2y nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00f3 ch\u1ecbu, nh\u01b0 kh\u00f4 mi\u1ec7ng, nh\u00ecn m\u1edd, v\u00e0 \u0111au qu\u1eb7n.<\/p>\n

– Domperidone<\/strong>, 10 \u0111\u1ebfn 40 mg u\u1ed1ng tr\u01b0\u1edbc b\u1eefa \u0103n 30 ph\u00fat, c\u00f3 hi\u1ec7u qu\u1ea3 \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, d\u00f9 c\u00f3 th\u1ec3 kh\u00f4ng t\u1ed1t h\u01a1n so v\u1edbi metoclopramide.<\/p>\n

– Erythromycin<\/strong> d\u00f9ng d\u01b0\u1edbi d\u1ea1ng l\u1ecfng ho\u1eb7c to\u1ea1 d\u01b0\u1ee3c c\u0169ng c\u00f3 th\u1ec3 gi\u00fap \u00edch. Erythromycin t\u00e1c d\u1ee5ng tr\u00ean c\u00e1c th\u1ee5 th\u1ec3 motilin, \u201cc\u00f3 ch\u1ee9c n\u0103ng qu\u00e9t d\u1ecdn trong \u0111\u01b0\u1eddng ru\u1ed9t,\u201d v\u00e0 r\u00fat ng\u1eafn th\u1eddi gian l\u00e0m r\u1ed7ng d\u1ea1 d\u00e0y.<\/p>\n

– N\u1ebfu th\u1ea5t b\u1ea1i trong \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa v\u00e0 v\u1eabn t\u1ed3n t\u1ea1i li\u1ec7t d\u1ea1 d\u00e0y n\u1eb7ng, c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i ph\u1eabu thu\u1eadt n\u1ed1i d\u1ea1 d\u00e0y v\u1edbi h\u1ed5ng tr\u00e0ng.<\/strong><\/p>\n

– C\u00f3 th\u1ec3 d\u00f9ng c\u00e1c b\u1eefa \u0103n v\u00e0o ban \u0111\u00eam, tr\u00e1nh \u0103n v\u00e0o ban ng\u00e0y v\u00e0 insulin \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh cho ph\u00f9 h\u1ee3p v\u1edbi th\u1eddi bi\u1ec3u d\u00f9ng b\u1eefa.<\/p>\n

– Li\u1ec7t d\u1ea1 d\u00e0y th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi bu\u1ed3n n\u00f4n v\u00e0 c\u00f3 th\u1ec3 do nguy\u00ean nh\u00e2n trung \u01b0\u01a1ng ho\u1eb7c ngo\u1ea1i bi\u00ean.<\/p>\n

– C\u00f3 th\u1ec3 d\u00f9ng h\u1ed7n h\u1ee3p sau: 45 mL Maalox<\/strong> (Rhone-Poulenc-Rorer, Collegeville, PA, U.S.A.), m\u1ed9t mu\u1ed7ng c\u00e0 ph\u00ea c\u1ed3n Donnatal Elixir<\/strong> (A. H. Robins, Wyeth-Ayerst Laboratories, Philadelphia, PA, U.S.A.; phenobarbital, hyoscyamine sulfate, atropine sulfate, v\u00e0 scopolamine hydrobromide<\/strong>), v\u00e0 m\u1ed9t mu\u1ed7ng c\u00e0 ph\u00ea Benadryl<\/strong> (Parke-Davis).<\/p>\n

N\u1ebfu li\u1ec1u l\u01b0\u1ee3ng thu\u1ed1c ch\u1ec9 s\u1eed d\u1ee5ng u\u1ed1ng ng\u00e0y m\u1ed9t l\u1ea7n, c\u00f3 th\u1ec3 d\u00f9ng 5 mL lidocaine d\u1ea1ng s\u1ec7t<\/strong> thay cho Benadryl.<\/p>\n

– H\u1ed7n h\u1ee3p tr\u00ean r\u1ea5t hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng bu\u1ed3n n\u00f4n v\u00e0 c\u00f3 th\u1ec3 d\u00f9ng m\u1ed7i 4 \u0111\u1ebfn 6 gi\u1edd m\u1ed9t l\u1ea7n.<\/p>\n

Khi li\u1ec7t d\u1ea1 d\u00e0y \u0111i k\u00e8m v\u1edbi \u0111au, c\u00f3 th\u1ec3 \u0111\u00e3 x\u1ea3y ra t\u00ecnh tr\u1ea1ng vi\u00eam d\u1ea1 d\u00e0y do d\u1ecbch m\u1eadt (bile-induced gastritis), \u0111i\u1ec1u n\u00e0y s\u1ebd \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n b\u1eb1ng c\u00e1ch d\u00f9ng Riopan<\/strong>, l\u00e0 m\u1ed9t h\u1ed7n h\u1ee3p magaldrate <\/strong>(aluminum\/magnesium hydroxide c\u1ee7a Whitehall Robins, Madison, NJ, U.S.A.). C\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p v\u1edbi cholestyramine, m\u1ed9t t\u00e1c nh\u00e2n chelat m\u1eadt .<\/p>\n

B- B\u1ec7nh l\u00fd Ru\u1ed9t<\/strong><\/p>\n

B\u1ec7nh l\u00fd ru\u1ed9t li\u00ean quan \u0111\u1ebfn ru\u1ed9t non v\u00e0 \u0111\u1ea1i tr\u00e0ng, c\u00f3 th\u1ec3 g\u00e2y ra t\u00e1o b\u00f3n m\u1ea1n t\u00ednh l\u1eabn ti\u00eau ch\u1ea3y \u1ed3 \u1ea1t do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, khi\u1ebfn cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng n\u00e0y \u0111\u1eb7c bi\u1ec7t kh\u00f3 kh\u0103n.<\/p>\n

C- C\u00e1c Kh\u00e1ng Sinh
\n<\/strong>
\n– T\u00ecnh tr\u1ea1ng \u1ee9 \u0111\u1ecdng trong \u0111\u01b0\u1eddng ru\u1ed9t k\u00e8m v\u1edbi sinh s\u1ea3n vi khu\u1ea9n qu\u00e1 m\u1ee9c c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n g\u00e2y ti\u00eau ch\u1ea3y.<\/p>\n

– Ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng bao g\u1ed3m tetracycline ho\u1eb7c trimethoprim-sulfamethoxazole.<\/p>\n

– Metronidazole 750 mg ng\u00e0y 2-3 l\u1ea7n c\u00f3 th\u1ec3 l\u00e0 t\u00e1c nh\u00e2n hi\u1ec7u q\u1ee7a nh\u1ea5t v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c d\u00f9ng trong \u00edt nh\u1ea5t 3 tu\u1ea7n.<\/p>\n

– C\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m, ho\u1eb7c n\u1ebfu \u0111\u01b0\u1ee3c, ki\u1ec3m tra b\u1eb1ng x\u00e9t nghi\u1ec7m hydrogen h\u01a1i th\u1edf, l\u00e0 ch\u1ec9 \u0111i\u1ec3m cho th\u1ea5y \u0111\u00e3 kh\u1ed1ng ch\u1ebf \u0111\u01b0\u1ee3c s\u1ef1 sinh s\u1ea3n qu\u00e1 m\u1ee9c c\u1ee7a vi khu\u1ea9n.<\/p>\n

D- Cholestyramine
\n<\/strong>
\n\u1ee8 \u0111\u1ecdng m\u1eadt c\u00f3 th\u1ec3 x\u1ea3y ra v\u00e0 g\u00e2y k\u00edch th\u00edch \u0111\u01b0\u1eddng ru\u1ed9t r\u1ea5t nhi\u1ec1u. Chelat ho\u00e1 c\u00e1c mu\u1ed1i m\u1eadt b\u1eb1ng cholestyramine, 4 g ng\u00e0y 3 l\u1ea7n pha n\u01b0\u1edbc u\u1ed1ng, s\u1ebd c\u1ea3i thi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng.<\/p>\n

E- Diphenoxylate k\u1ebft h\u1ee3p v\u1edbi Atropine<\/strong><\/p>\n

Lomotil (Searle, Chicago, IL) 2 mg, ng\u00e0y u\u1ed1ng 4 l\u1ea7n gi\u00fap ki\u1ec3m so\u00e1t ti\u00eau ch\u1ea3y, m\u1eb7c d\u00f9 nguy c\u01a1 ph\u00ecnh \u0111\u1ea1i tr\u00e0ng nhi\u1ec5m \u0111\u1ed9c (toxic megacolon) c\u00f3 th\u1ec3 x\u1ea3y ra, do \u0111\u00f3 c\u1ea7n ph\u1ea3i th\u1eadt th\u1eadn tr\u1ecdng.<\/p>\n

F- Ch\u1ebf \u0111\u1ed9 \u0103n<\/strong><\/p>\n

– B\u1ec7nh nh\u00e2n c\u00f3 ti\u00eau ho\u00e1 k\u00e9m n\u00ean \u0111\u01b0\u1ee3c khuy\u00ean d\u00f9ng ch\u1ebf \u0111\u1ed9 \u0103n kh\u00f4ng c\u00f3 gluten.<\/p>\n

– M\u1ed9t s\u1ed1 lo\u1ea1i ch\u1ea5t x\u01a1 c\u00f3 th\u1ec3 t\u0103ng nguy c\u01a1 h\u00ecnh th\u00e0nh bezoar \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh nh\u01b0 li\u1ec7t d\u1ea1 d\u00e0y ho\u1eb7c t\u00e1o b\u00f3n.<\/p>\n

– Ch\u1ea5t x\u01a1 ho\u00e0 tan psyllium c\u00f3 th\u1ec3 c\u00f3 \u00edch trong tr\u01b0\u1eddng h\u1ee3p ti\u00eau ch\u1ea3y do kh\u1ea3 n\u0103ng h\u00fat n\u01b0\u1edbc c\u1ee7a n\u00f3, t\u1ea1o khu\u00f4n ph\u00e2n t\u1ed1t h\u01a1n v\u00e0 l\u00e0m ch\u1eadm nhu \u0111\u1ed9ng ru\u1ed9t.<\/p>\n

G- Suy t\u1ee5y ngo\u1ea1i ti\u1ebft<\/strong><\/p>\n

– Khi x\u1ea3y ra gi\u1ea3m b\u00e0i ti\u1ebft c\u1ee7a t\u1ee5y ngo\u1ea1i ti\u1ebft, huy\u1ec1n d\u1ecbch Viokase (A. H. Robins) v\u1edbi li\u1ec1u cao (10\u201318 mu\u1ed7ng canh\/ng\u00e0y) c\u00f3 th\u1ec3 hi\u1ec7u qu\u1ea3.<\/p>\n

– Clonidine c\u0169ng mang l\u1ea1i m\u1ed9t s\u1ed1 k\u1ebft qu\u1ea3 khi \u0111\u01b0\u1ee3c d\u00f9ng trong m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng nh\u1ecf, c\u00f3 th\u1ec3 do nguy\u00ean nh\u00e2n khi\u1ebfm khuy\u1ebft th\u1ee5 th\u1ec3 \u03b12-adrenergic \u1edf bi\u1ec3u m\u00f4 ru\u1ed9t.<\/p>\n

– Khi ti\u00eau ch\u1ea3y \u0111\u1eb7c bi\u1ec7t kh\u00e1ng ng\u1ef1 v\u1edbi c\u00e1c thu\u1ed1c k\u1ec3 tr\u00ean, n\u00f3 c\u00f3 th\u1ec3 s\u1ebd \u0111\u00e1p \u1ee9ng v\u1edbi octreotide. C\u1ea7n s\u1eed d\u1ee5ng li\u1ec1u kho\u1ea3ng 0,1\u20130,5 mg\/kg\/ng\u00e0y \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ch\u1ee9ng ti\u00eau ch\u1ea3y do b\u1ec7nh l\u00fd ru\u1ed9t \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n

BS. \u0110\u1ed2NG NG\u1eccC KHANH -BV Ho\u00e0n M\u1ef9 S\u00e0i G\u00f2n bi\u00ean d\u1ecbch <\/strong><\/p>\n


\n<\/strong>T\u00e0i li\u1ec7u tham kh\u1ea3o: Vinik AI, Holland MT, LeBeau JM, et al. Diabetic neuropathies. Diabetes Care 1992;15:1926\u20131975.<\/p>\n","protected":false},"excerpt":{"rendered":"

– C\u1ea7n gi\u1ea3m c\u00e1c ch\u1ea5t b\u00e9o v\u00ec ch\u00fang c\u00f3 khuynh h\u01b0\u1edbng k\u00e9o d\u00e0i vi\u1ec7c l\u00e0m r\u1ed7ng d\u1ea1 d\u00e0y. – C\u00f3 th\u1ec3 d\u00f9ng th\u00eam metoclopramide 10 mg t\u1eeb 2 \u0111\u1ebfn 4 l\u1ea7n m\u1ed7i ng\u00e0y, n\u1ebfu c\u1ea7n thi\u1ebft. Tuy nhi\u00ean thu\u1ed1c s\u1ebd kh\u00f4ng \u0111\u01b0\u1ee3c h\u1ea5p thu t\u1ed1t n\u1ebfu c\u00f2n nhi\u1ec1u th\u1ee9c \u0103n t\u1ed3n d\u01b0 do li\u1ec7t d\u1ea1 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1249],"tags":[],"class_list":["post-273922","post","type-post","status-publish","format-standard","hentry","category-tin-tuc-y-te"],"acf":[],"_links":{"self":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/273922","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/comments?post=273922"}],"version-history":[{"count":1,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/273922\/revisions"}],"predecessor-version":[{"id":311075,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/273922\/revisions\/311075"}],"wp:attachment":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/media?parent=273922"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/categories?post=273922"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/tags?post=273922"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}