{"id":17896,"date":"2023-04-14T21:04:25","date_gmt":"2023-04-14T14:04:25","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=17896"},"modified":"2023-04-18T12:34:26","modified_gmt":"2023-04-18T05:34:26","slug":"ha-kali-mau-tren-benh-nhan-hoi-suc-phau-thuat-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/ha-kali-mau-tren-benh-nhan-hoi-suc-phau-thuat-tim\/","title":{"rendered":"H\u1ea1 kali m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim"},"content":{"rendered":"<p><strong>H\u1ea1 kali m\u00e1u l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p sau ph\u1eabu thu\u1eadt tim \u1edf b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c. Khi kali m\u00e1u th\u1ea5p, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n nh\u1ecbp tim, co th\u1eaft \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 suy h\u00f4 h\u1ea5p. \u0110\u1ec3 \u0111i\u1ec1u tr\u1ecb h\u1ea1 kali m\u00e1u, c\u1ea7n t\u0103ng l\u01b0\u1ee3ng kali trong th\u1ef1c ph\u1ea9m ho\u1eb7c s\u1eed d\u1ee5ng c\u00e1c dung d\u1ecbch ch\u1ee9a kali. Th\u00eam v\u00e0o \u0111\u00f3, vi\u1ec7c ch\u1ec9 \u0111\u1ecbnh th\u00eam kali trong c\u00e1c \u00a0lo\u1ea1i d\u1ecbch truy\u1ec1n t\u0129nh m\u1ea1ch c\u0169ng l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1 n\u00e0y.<\/strong><\/p>\n<h2><strong>1.Nguy\u00ean nh\u00e2n h\u1ea1 kali m\u00e1u<\/strong><\/h2>\n<ul>\n<li>T\u0103ng l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u \u0111\u00e1ng k\u1ec3 m\u00e0 kh\u00f4ng b\u1ed5 sung \u0111\u1ee7 kali. Vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u m\u1ea1nh c\u00f3 th\u1ec3 g\u00e2y ra b\u00e0i ti\u1ebft n\u01b0\u1edbc ti\u1ec3u v\u00e0 kali \u0111\u00e1ng k\u1ec3 trong giai \u0111o\u1ea1n sau ph\u1eabu thu\u1eadt s\u1edbm. N\u1ed3ng \u0111\u1ed9 kali trong c\u01a1 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh b\u1edfi c\u00e1c c\u01a1 ch\u1ebf \u0111i\u1ec1u ti\u1ebft nh\u01b0 tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn v\u00e0 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Tuy nhi\u00ean, khi s\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u, thu\u1ed1c s\u1ebd k\u00edch th\u00edch th\u1eadn \u0111\u00e0o th\u1ea3i n\u01b0\u1edbc v\u00e0 mu\u1ed1i, bao g\u1ed3m c\u1ea3 kali, th\u00f4ng qua \u0111\u01b0\u1eddng ti\u1ec3u. Vi\u1ec7c \u0111\u00e0o th\u1ea3i kali qu\u00e1 nhi\u1ec1u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng h\u1ea1 kali m\u00e1u.<\/li>\n<li>Insulin \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, gi\u00fap chuy\u1ec3n kali b\u00ean ngo\u00e0i t\u1ebf b\u00e0o v\u00e0o trong t\u1ebf b\u00e0o.C\u01a1 ch\u1ebf chuy\u1ec3n kali b\u00ean ngo\u00e0i t\u1ebf b\u00e0o v\u00e0o trong t\u1ebf b\u00e0o \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi c\u00e1c k\u00eanh kali trong t\u1ebf b\u00e0o. Khi insulin k\u00edch th\u00edch t\u1ebf b\u00e0o, n\u00f3 s\u1ebd k\u00edch ho\u1ea1t c\u00e1c k\u00eanh kali trong m\u00e0ng t\u1ebf b\u00e0o, l\u00e0m cho ch\u00fang m\u1edf r\u1ed9ng v\u00e0 cho kali di chuy\u1ec3n t\u1eeb b\u00ean ngo\u00e0i t\u1ebf b\u00e0o v\u00e0o b\u00ean trong. Khi kali di chuy\u1ec3n v\u00e0o b\u00ean trong t\u1ebf b\u00e0o, n\u1ed3ng \u0111\u1ed9 kali trong huy\u1ebft thanh s\u1ebd gi\u1ea3m, gi\u00fap \u0111i\u1ec1u h\u00f2a ho\u1ea1t \u0111\u1ed9ng c\u01a1 b\u1ea3n c\u1ee7a c\u00e1c t\u1ebf b\u00e0o v\u00e0 d\u00e2y th\u1ea7n kinh.<\/li>\n<li>H\u1ea1 magi\u00ea (th\u01b0\u1eddng do s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u) c\u00f3 th\u1ec3 g\u00e2y ra h\u1ea1 kali m\u00e1u. C\u01a1 ch\u1ebf h\u1ea1 kali m\u00e1u do h\u1ea1 magi\u00ea c\u00f3 th\u1ec3 x\u1ea3y ra khi s\u1ef1 \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu magi\u00ea trong th\u1eadn d\u1eabn \u0111\u1ebfn t\u0103ng l\u01b0\u1ee3ng magi\u00ea trong n\u01b0\u1edbc ti\u1ec3u \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf. S\u1ef1 t\u0103ng l\u01b0\u1ee3ng magi\u00ea trong n\u01b0\u1edbc ti\u1ec3u l\u00e0m gi\u1ea3m s\u1ef1 t\u00e1i h\u1ea5p thu kali, d\u1eabn \u0111\u1ebfn h\u1ea1 kali m\u00e1u. Ngo\u00e0i ra, h\u1ea1 magi\u00ea c\u0169ng c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c k\u00eanh kali trong t\u1ebf b\u00e0o, g\u00e2y ra h\u1ea1 kali m\u00e1u.<\/li>\n<li>L\u01b0\u1ee3ng d\u1ecbch d\u1ea1 d\u00e0y \u0111\u00e1ng k\u1ec3 \u0111\u01b0\u1ee3c \u0111\u00e0o th\u1ea3i qua \u1ed1ng stone d\u1ea1 d\u00e0y.<\/li>\n<\/ul>\n<h2><strong>2.Tri\u1ec7u ch\u1ee9ng h\u1ea1 kali m\u00e1u<\/strong><\/h2>\n<p>Tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u00ecnh tr\u1ea1ng n\u00e0y bao g\u1ed3m c\u1ea3m gi\u00e1c m\u1ec7t m\u1ecfi, bu\u1ed3n n\u00f4n, \u0111au b\u1ee5ng, co gi\u1eadt v\u00e0 \u0111\u1ed9t ng\u1ed9t m\u1ea5t \u00fd th\u1ee9c. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c x\u1eed l\u00fd k\u1ecbp th\u1eddi, h\u1ea1 kali m\u00e1u c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng nh\u01b0\u00a0 suy tim, ho\u1eb7c th\u1eadm ch\u00ed t\u1eed vong.<\/p>\n<p>M\u1ed1i quan t\u00e2m ch\u00ednh v\u1edbi h\u1ea1 kali m\u00e1u \u1edf b\u1ec7nh nh\u00e2n tim m\u1ea1ch l\u00e0 g\u00e2y ra c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim t\u00e1i ph\u00e1t do t\u0103ng t\u1ef1 \u0111\u1ed9ng t\u00ednh c\u1ee7a tim v\u00e0 ch\u1eadm kh\u1eed \u0111\u1ec1u th\u1ea5t. H\u1ea1 kali m\u00e1u c\u00f3 th\u1ec3 g\u00e2y ra c\u01a1n nh\u1ecbp nhanh nh\u0129, block nh\u0129 th\u1ea5t. ECG c\u00f3 th\u1ec3 th\u1ec3 hi\u1ec7n c\u00e1c \u0111o\u1ea1n ST ch\u00eanh xu\u1ed1ng, bi\u00ean \u0111\u1ed9 s\u00f3ng T gi\u1ea3m v\u00e0 xu\u1ea5t hi\u1ec7n s\u00f3ng U. C\u00e1c y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 th\u00fac \u0111\u1ea9y s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a r\u1ed1i lo\u1ea1n nh\u1ecbp tim bao g\u1ed3m thi\u1ebfu m\u00e1u c\u01a1 tim, digoxin v\u00e0 m\u1ee9c magi\u00ea th\u1ea5p (th\u01b0\u1eddng g\u1eb7p sau CPB). H\u1ea1 kali c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1 \u1edf c\u00e1c c\u01a1 h\u00f4 h\u1ea5p, \u0111\u01b0\u1eddng ti\u00eau h\u00f3a (g\u00e2y t\u1eafc ru\u1ed9t).<\/p>\n<h2><strong>3.\u0110i\u1ec1u tr\u1ecb h\u1ea1 kali m\u00e1u<\/strong><\/h2>\n<p>\u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ea5t k\u1ef3 m\u1ee9c kali n\u00e0o d\u01b0\u1edbi m\u1ee9c b\u00ecnh th\u01b0\u1eddng, m\u1eb7c d\u00f9 c\u00e1c thay \u0111\u1ed5i ECG kh\u00f4ng tr\u1edf n\u00ean r\u00f5 r\u00e0ng cho \u0111\u1ebfn khi m\u1ee9c&lt;3 mEq \/ L.<\/p>\n<ul>\n<li>R\u1ea5t c\u1ea7n thi\u1ebft ph\u1ea3i \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u truy\u1ec1n dung d\u1ecbch kali clorua (KCl), v\u00ec t\u0103ng kali c\u1ea5p t\u00ednh c\u00f3 th\u1ec3\u00a0 r\u1ea5t nhanh khi vi\u1ec7c b\u00e0i ti\u1ebft n\u01b0\u1edbc ti\u1ec3u ho\u1eb7c ch\u1ee9c n\u0103ng th\u1eadn b\u1ecb suy gi\u1ea3m. T\u1ed1c \u0111\u1ed9 truy\u1ec1n ch\u1eadm h\u01a1n \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, v\u1edbi vi\u1ec7c ki\u1ec3m tra l\u1ea1i m\u1ee9c kali m\u00e1u th\u01b0\u1eddng xuy\u00ean. \u0110\u1eb7c bi\u1ec7t c\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c ngu\u1ed3n m\u1ea5t kali qua \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ho\u1eb7c \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u00f3 th\u1ec3 y\u00eau c\u1ea7u ph\u1ea3i b\u1ed5 sung m\u1ed9t c\u00e1ch t\u00edch c\u1ef1c h\u01a1n.<\/li>\n<li>Sau khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c g\u1ee1 \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, kali u\u1ed1ng qua \u0111\u01b0\u1eddng mi\u1ec7ng (vi\u00ean 10-20 mEq l\u00ean \u0111\u1ebfn ba \u0111\u1ebfn b\u1ed1n l\u1ea7n m\u1ed7i ng\u00e0y) th\u01b0\u1eddng \u0111\u1ee7 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb m\u1ee9c kali \u1edf m\u1ee9c 3-4 mEq \/ L. Tuy nhi\u00ean, li\u1ec1u 40-60 mEq ba \u0111\u1ebfn b\u1ed1n l\u1ea7n m\u1ed7i ng\u00e0y c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft \u0111\u1ec3 duy tr\u00ec m\u1ee9c kali b\u00ecnh th\u01b0\u1eddng khi kali &lt;3 mEq \/ L.<\/li>\n<li>Thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t trong suy tim, nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng c\u1ea5p c\u1ee9u \u0111\u1ec3 t\u0103ng kali m\u00e1u.C\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali th\u01b0\u1eddng ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch ng\u0103n ch\u1eb7n s\u1ef1 m\u1ea5t kali trong \u0111\u01b0\u1eddng ti\u1ec3u. M\u1ed9t s\u1ed1 v\u00ed d\u1ee5 v\u1ec1 c\u00e1c lo\u1ea1i thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali bao g\u1ed3m: Spironolactone: Thu\u1ed1c n\u00e0y ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch ng\u0103n ch\u1eb7n s\u1ef1 th\u1ee5 th\u1ec3 c\u1ee7a aldosterone tr\u00ean c\u00e1c t\u1ebf b\u00e0o th\u1eadn, gi\u00fap gi\u1eef l\u1ea1i kali trong c\u01a1 th\u1ec3.<\/li>\n<\/ul>\n<h2><strong>4.K\u1ebft lu\u1eadn v\u1ec1 h\u1ea1 kali m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim<\/strong><\/h2>\n<p>L\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 ph\u1ed5 bi\u1ebfn tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nh\u1eefng bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u01b0 r\u1ed1i lo\u1ea1n nh\u1ecbp tim v\u00e0 suy tim. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 m\u1ee9c \u0111\u1ed9 kali m\u00e1u l\u00e0 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c qu\u1ea3n l\u00fd h\u1ea1 kali m\u00e1u. Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch trung t\u00e2m, vi\u1ec7c truy\u1ec1n kali qua t\u0129nh m\u1ea1ch ngo\u1ea1i vi c\u1ea7n \u0111\u01b0\u1ee3c h\u1ea1n ch\u1ebf. Vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali v\u00e0 b\u1ed5 sung magi\u00ea c\u00f3 th\u1ec3 gi\u00fap duy tr\u00ec m\u1ee9c kali m\u00e1u \u1ed5n \u0111\u1ecbnh. Tuy nhi\u00ean, vi\u1ec7c gi\u1ea3m \u0111\u01b0\u1eddng huy\u1ebft qu\u00e1 m\u1ee9c c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra di chuy\u1ec3n kali ra ngo\u00e0i t\u1ebf b\u00e0o. Do \u0111\u00f3, c\u1ea7n \u0111\u00e1nh gi\u00e1 m\u1ee9c kali m\u00e1u c\u1ea9n th\u1eadn \u0111\u1ec3 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m.<\/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 sau ph\u1eabu thu\u1eadt tim.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>H\u1ea1 kali m\u00e1u l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p sau ph\u1eabu thu\u1eadt tim \u1edf b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c. Khi kali m\u00e1u th\u1ea5p, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n nh\u1ecbp tim, co th\u1eaft \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 suy h\u00f4 h\u1ea5p. \u0110\u1ec3 \u0111i\u1ec1u tr\u1ecb h\u1ea1 kali m\u00e1u, c\u1ea7n t\u0103ng l\u01b0\u1ee3ng kali trong th\u1ef1c ph\u1ea9m ho\u1eb7c s\u1eed d\u1ee5ng [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":20177,"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>H\u1ea1 kali m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ea1 kali m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p, Tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"H\u1ea1 kali m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim - 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