{"id":17823,"date":"2023-04-10T18:48:03","date_gmt":"2023-04-10T11:48:03","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=17823"},"modified":"2023-04-19T15:08:53","modified_gmt":"2023-04-19T08:08:53","slug":"tong-quan-phuong-phap-thay-the-than-trong-hoi-suc-phau-thuat-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/tong-quan-phuong-phap-thay-the-than-trong-hoi-suc-phau-thuat-tim\/","title":{"rendered":"T\u1ed5ng quan ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf th\u1eadn trong h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim"},"content":{"rendered":"<p><strong>Ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf th\u1eadn (RRT) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 lo\u1ea1i b\u1ecf s\u1ef1 d\u01b0 th\u1eeba ch\u1ea5t l\u1ecfng v\u00e0 \u0111\u1ed9c h\u1ea1i \u0111\u1ec3 c\u1ea3i thi\u1ec7n c\u00e2n b\u1eb1ng \u0111i\u1ec7n gi\u1ea3i v\u00e0 lo\u1ea1i b\u1ecf c\u00e1c ch\u1ea5t th\u1ea3i nit\u01a1 kh\u00e1c.Tuy nhi\u00ean, quy\u1ebft \u0111\u1ecbnh quan tr\u1ecdng v\u00e0 \u0111\u00f4i khi kh\u00f3 kh\u0103n \u0111\u1ec3 \u0111\u01b0a ra l\u00e0 li\u1ec7u c\u00f3 n\u00ean b\u1eaft \u0111\u1ea7u RRT khi xu\u1ea5t hi\u1ec7n d\u1ea5u hi\u1ec7u suy th\u1eadn c\u1ea5p t\u00ednh hay \u0111\u1ebfn khi thi\u1ec3u ni\u1ec7u hay t\u0103ng creatinin huy\u1ebft thanh.<\/strong><\/p>\n<h2><strong>1. Ch\u1ec9 \u0111\u1ecbnh thay th\u1ebf th\u1eadn:<\/strong><\/h2>\n<ul>\n<li>Nh\u1eefng ch\u1ec9 \u0111\u1ecbnh quan tr\u1ecdng nh\u1ea5t \u0111\u1ec3 b\u1eaft \u0111\u1ea7u RRT l\u00e0 qu\u00e1 t\u1ea3i ch\u1ea5t l\u1ecfng, t\u0103ng kali m\u00e1u. C\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c c\u1ee7a t\u0103ng ure m\u00e1u cao ch\u1eb3ng h\u1ea1n nh\u01b0: vi\u00eam m\u00e0ng tim ho\u1eb7c ch\u1ea3y m\u00e1u \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, c\u0169ng n\u00ean th\u00fac \u0111\u1ea9y b\u1eaft \u0111\u1ea7u RRT, m\u1eb7c d\u00f9 ch\u00fang hi\u1ebfm g\u1eb7p trong t\u00ecnh hu\u1ed1ng c\u1ea5p t\u00ednh. Tuy nhi\u00ean, quy\u1ebft \u0111\u1ecbnh kh\u00f3 kh\u0103n \u0111\u1ec3 \u0111\u01b0a ra l\u00e0 li\u1ec7u c\u00f3 n\u00ean b\u1eaft \u0111\u1ea7u RRT khi xu\u1ea5t hi\u1ec7n d\u1ea5u hi\u1ec7u suy th\u1eadn c\u1ea5p t\u00ednh hay \u0111\u1ebfn khi thi\u1ec3u ni\u1ec7u hay t\u0103ng creatinin huy\u1ebft thanh (SCr), \u0111\u1eb7c bi\u1ec7t l\u00e0 khi SCr c\u00f3 xu h\u01b0\u1edbng b\u1ecb t\u0103ng tr\u1ec5 h\u01a1n so v\u1edbi m\u1ee9c \u0111\u1ed9 suy th\u1eadn. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u v\u1ec1 b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim \u0111\u00e3 cho th\u1ea5y r\u1eb1ng vi\u1ec7c th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt l\u1ecdc m\u00e1u tr\u01b0\u1edbc khi b\u1ec7nh nh\u00e2n ph\u00e1t tri\u1ec3n d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng suy th\u1eadn v\u00e0 tr\u01b0\u1edbc khi t\u0103ng SCr \u0111\u00e1ng k\u1ec3 x\u1ea3y ra, cho th\u1ea5y c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3.<\/li>\n<li>M\u1ed9t y\u1ebfu t\u1ed1 kh\u00e1c c\u1ea7n xem x\u00e9t \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn v\u1eeba v\u00e0 trung b\u00ecnh (SCr&gt; 2-2,5 mg\/dL) l\u00e0 s\u1eed d\u1ee5ng &#8220;ph\u00f2ng ng\u1eeba&#8221; l\u1ecdc m\u00e1u tr\u01b0\u1edbc ph\u1eabu thu\u1eadt. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng \u0111i\u1ec1u n\u00e0y gi\u1ea3m nhu c\u1ea7u s\u1eed d\u1ee5ng RRT sau ph\u1eabu thu\u1eadt, \u0111\u1ed3ng th\u1eddi gi\u1ea3m t\u1ed5ng s\u1ed1 b\u1ec7nh n\u1eb7ng v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong.<\/li>\n<li>RRT bao g\u1ed3m nhi\u1ec1u qu\u00e1 tr\u00ecnh \u0111\u1ec3 lo\u1ea1i b\u1ecf th\u1ec3 t\u00edch, ch\u1ea5t \u0111\u1ed9c. M\u1ed9t \u0111\u1ed9 ch\u00eanh \u00e1p xuy\u00ean m\u00e0ng (th\u1ef1c ch\u1ea5t l\u00e0 \u00e1p l\u1ef1c th\u1ee7y t\u0129nh) th\u00fac \u0111\u1ea9y n\u01b0\u1edbc, huy\u1ebft thanh (si\u00eau l\u1ecdc) qua m\u00e0ng b\u00e1n th\u1ea5m. Lo\u1ea1i b\u1ecf ch\u1ea5t b\u1eb1ng s\u1ef1 khu\u1ebfch t\u00e1n \u0111\u01b0\u1ee3c th\u00fac \u0111\u1ea9y b\u1edfi s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 n\u1ed3ng \u0111\u1ed9 ch\u1ea5t r\u1eafn gi\u1eefa huy\u1ebft t\u01b0\u01a1ng v\u00e0 dung d\u1ecbch \u0111i\u1ec7n gi\u1ea3i \u1edf ph\u00eda b\u00ean kia c\u1ee7a m\u00e0ng.<\/li>\n<\/ul>\n<h2><strong>2.C\u00e1c h\u00ecnh th\u1ee9c thay th\u1ebf th\u1eadn<\/strong><\/h2>\n<p>C\u00e1c h\u00ecnh th\u1ee9c RRT ph\u1ed5 bi\u1ebfn nh\u1ea5t \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim l\u00e0 l\u1ecdc m\u00e1u ng\u1eaft qu\u00e3ng v\u00e0 l\u1ecdc m\u00e1u li\u00ean t\u1ee5c qua t\u0129nh m\u1ea1ch. L\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p ph\u00f9 h\u1ee3p ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1c ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng (m\u1ee5c \u0111\u00edch ch\u00ednh l\u00e0 lo\u1ea1i b\u1ecf th\u1ec3 t\u00edch hay ch\u1ea5t \u0111\u1ed9c), v\u00e0 s\u1ef1 \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng c\u1ee7a b\u1ec7nh nh\u00e2n. C\u1ea3 hai ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u1ec1u li\u00ean quan \u0111\u1ebfn\u00a0 k\u1ebft qu\u1ea3\u00a0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t.<\/p>\n<h3><strong>2.1.L\u1ecdc m\u00e1u ng\u1eaft qu\u00e3ng (IHD)\u00a0 <\/strong><\/h3>\n<p>\u0110\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua vi\u1ec7c l\u1ecdc m\u00e1u qua m\u1ed9t b\u1ed9 l\u1ecdc, lo\u1ea1i b\u1ecf c\u00e1c ch\u1ea5t th\u1ea3i\u00a0 kh\u1ecfi m\u00e1u, sau \u0111\u00f3 tr\u1ea3 l\u1ea1i m\u00e1u \u0111\u00e3 \u0111\u01b0\u1ee3c tinh ch\u1ebf v\u00e0o c\u01a1 th\u1ec3 b\u1ec7nh nh\u00e2n.Tuy nhi\u00ean, IHD c\u0169ng c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf nh\u01b0 s\u1ef1 m\u1ea5t n\u01b0\u1edbc v\u00e0 c\u00e1c ch\u1ea5t dinh d\u01b0\u1ee1ng quan tr\u1ecdng trong qu\u00e1 tr\u00ecnh l\u1ecdc.To\u00e0n b\u1ed9 qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e1u th\u00f4ng qua IHD th\u01b0\u1eddng k\u00e9o d\u00e0i t\u1eeb 3 \u0111\u1ebfn 4 gi\u1edd v\u00e0 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n 2-3 l\u1ea7n m\u1ed7i tu\u1ea7n.<\/p>\n<p>C\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh IHD bao g\u1ed3m:<\/p>\n<ul>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111\u00f4ng m\u00e1u ho\u1eb7c r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u: V\u00ec qu\u00e1 tr\u00ecnh IHD c\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng \u0111\u00f4ng m\u00e1u, n\u00ean b\u1ec7nh nh\u00e2n c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111\u00f4ng m\u00e1u ho\u1eb7c r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u nh\u01b0 b\u1ec7nh nh\u00e2n suy gi\u1ea3m ti\u1ec3u c\u1ea7u, h\u1ed9i ch\u1ee9ng gi\u1ea3m ti\u1ec3u c\u1ea7u, b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf \u0111\u00f4ng m\u00e1u ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed ch\u1ea3y m\u00e1u n\u1ed9i b\u1ed9 l\u00e0 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng IHD.<\/li>\n<li>B\u1ec7nh nh\u00e2n s\u1ed1c: B\u1ec7nh nh\u00e2n \u0111ang trong t\u00ecnh tr\u1ea1ng s\u1ed1c c\u1ea5p t\u00ednh ho\u1eb7c s\u1ed1c nhi\u1ec5m tr\u00f9ng n\u1eb7ng kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng IHD do t\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 g\u00e2y nguy hi\u1ec3m cho b\u1ec7nh nh\u00e2n.<\/li>\n<li>B\u1ec7nh nh\u00e2n suy tim: B\u1ec7nh nh\u00e2n suy tim n\u1eb7ng kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng IHD do t\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra nguy c\u01a1 t\u0103ng huy\u1ebft \u00e1p v\u00e0 suy tim.<\/li>\n<li>B\u1ec7nh nh\u00e2n suy gan n\u1eb7ng: B\u1ec7nh nh\u00e2n suy gan n\u1eb7ng kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng IHD do qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e1u c\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng s\u1ee5t gi\u1ea3m \u00e1p su\u1ea5t v\u00e0 l\u00e0m t\u1ed5n th\u01b0\u01a1ng gan.<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd ph\u1ed5i n\u1eb7ng: B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd ph\u1ed5i n\u1eb7ng nh\u01b0 suy h\u00f4 h\u1ea5p ho\u1eb7c vi\u00eam ph\u1ed5i c\u1ea5p t\u00ednh kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng IHD do qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e1u c\u00f3 th\u1ec3 g\u00e2y ra t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p n\u1eb7ng.<\/li>\n<\/ul>\n<h3><strong>2.3.L\u1ecdc m\u00e1u li\u00ean t\u1ee5c (CRRT)<\/strong><\/h3>\n<p>\u0110\u01b0\u1ee3c th\u1ef1c hi\u1ec7n th\u00f4ng qua vi\u1ec7c l\u1ecdc m\u00e1u li\u00ean t\u1ee5c qua m\u1ed9t b\u1ed9 l\u1ecdc, lo\u1ea1i b\u1ecf c\u00e1c ch\u1ea5t th\u1ea3i kh\u1ecfi m\u00e1u v\u00e0 tr\u1ea3 l\u1ea1i n\u01b0\u1edbc v\u00e0 c\u00e1c ch\u1ea5t dinh d\u01b0\u1ee1ng quan tr\u1ecdng v\u00e0o c\u01a1 th\u1ec3 b\u1ec7nh nh\u00e2n. CRRT \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u00e0 ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb suy th\u1eadn c\u1ea5p t\u00ednh sau ph\u1eabu thu\u1eadt tim.Tuy nhi\u00ean, CRRT c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf nh\u01b0 c\u1ea7n thi\u1ebft ph\u1ea3i s\u1eed d\u1ee5ng m\u1ed9t thi\u1ebft b\u1ecb l\u1edbn v\u00e0 \u0111\u1eaft ti\u1ec1n, \u0111\u1ed3ng th\u1eddi c\u1ea7n c\u00f3 s\u1ef1 chuy\u00ean m\u00f4n cao \u0111\u1ec3 v\u1eadn h\u00e0nh.<\/p>\n<h2><strong>3.K\u1ebft lu\u1eadn:<\/strong><\/h2>\n<p>Ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf th\u1eadn (RRT) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ti\u1ec7n quan tr\u1ecdng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb suy th\u1eadn c\u1ea5p t\u00ednh sau ph\u1eabu thu\u1eadt tim. RRT c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 lo\u1ea1i b\u1ecf d\u01b0 th\u1eeba ch\u1ea5t l\u1ecfng, c\u1ea3i thi\u1ec7n c\u00e2n b\u1eb1ng \u0111i\u1ec7n gi\u1ea3i v\u00e0 lo\u1ea1i b\u1ecf c\u00e1c ch\u1ea5t th\u1ea3i nit\u01a1 kh\u00e1c. Vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p RRT ph\u00f9 h\u1ee3p ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1c ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng, v\u00e0 s\u1ef1 \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng c\u1ee7a b\u1ec7nh nh\u00e2n. C\u00e1c h\u00ecnh th\u1ee9c ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a RRT l\u00e0 l\u1ecdc m\u00e1u \u0111\u1ecbnh k\u1ef3 v\u00e0 l\u1ecdc m\u00e1u li\u00ean t\u1ee5c qua t\u0129nh m\u1ea1ch. S\u1eed d\u1ee5ng &#8220;ph\u00f2ng ng\u1eeba&#8221; l\u1ecdc m\u00e1u tr\u01b0\u1edbc ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 gi\u1ea3m nhu c\u1ea7u s\u1eed d\u1ee5ng RRT sau ph\u1eabu thu\u1eadt v\u00e0 gi\u1ea3m t\u1ed5ng s\u1ed1 b\u1ec7nh n\u1eb7ng v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong.<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/\"><strong>B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/strong><\/a> \u0111\u00e3 \u0111\u01b0a h\u1ec7 th\u1ed1ng m\u00e1y m\u00f3c, thi\u1ebft b\u1ecb hi\u1ec7n \u0111\u1ea1i \u0111\u1ea1t chu\u1ea9n v\u00e0o c\u00f4ng t\u00e1c th\u0103m kh\u00e1m, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 c\u00e1c b\u1ec7nh l\u00fd v\u1ec1 h\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf th\u1eadn (RRT) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 lo\u1ea1i b\u1ecf s\u1ef1 d\u01b0 th\u1eeba ch\u1ea5t l\u1ecfng v\u00e0 \u0111\u1ed9c h\u1ea1i \u0111\u1ec3 c\u1ea3i thi\u1ec7n c\u00e2n b\u1eb1ng \u0111i\u1ec7n gi\u1ea3i v\u00e0 lo\u1ea1i b\u1ecf c\u00e1c ch\u1ea5t th\u1ea3i nit\u01a1 kh\u00e1c.Tuy nhi\u00ean, quy\u1ebft \u0111\u1ecbnh quan tr\u1ecdng v\u00e0 \u0111\u00f4i khi kh\u00f3 kh\u0103n \u0111\u1ec3 \u0111\u01b0a ra l\u00e0 li\u1ec7u c\u00f3 n\u00ean b\u1eaft [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":17834,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>T\u1ed5ng quan ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf th\u1eadn trong h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim<\/title>\n<meta name=\"description\" content=\"Thay th\u1ebf th\u1eadn trong h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy th\u1eadn c\u1ea5p. 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