{"id":17903,"date":"2023-04-14T21:01:15","date_gmt":"2023-04-14T14:01:15","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=17903"},"modified":"2023-04-18T12:35:02","modified_gmt":"2023-04-18T05:35:02","slug":"dieu-tri-giam-co2-mau-tren-benh-nhan-sau-phau-thuat-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/dieu-tri-giam-co2-mau-tren-benh-nhan-sau-phau-thuat-tim\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb gi\u1ea3m CO2 m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim"},"content":{"rendered":"<p><strong>Gi\u1ea3m CO2 m\u00e1u l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng trong qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n th\u1edf m\u00e1y. Vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh t\u1ea7n s\u1ed1 h\u00f4 h\u1ea5p v\u00e0 th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng l\u00e0 m\u1ed9t trong nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m CO2 m\u00e1u. \u0110\u1ed3ng th\u1eddi, \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng c\u1ee7a s\u1ef1 th\u00f4ng kh\u00ed v\u00e0 oxy h\u00f3a, ki\u1ec3m tra c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 ph\u1ed5i- m\u00e0ng ph\u1ed5i v\u00e0 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a m\u00e1y th\u1edf l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o ch\u1ea5t l\u01b0\u1ee3ng ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n th\u00edch h\u1ee3p. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u00e0y s\u1ebd gi\u00fap gi\u1ea3m nguy c\u01a1 c\u00e1c bi\u1ebfn ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n.<\/strong><\/p>\n<h2>1. L\u00e2m s\u00e0ng<\/h2>\n<p>T\u0103ng CO2 m\u00e1u l\u00e0 m\u1ed9t trong nh\u1eefng bi\u1ebfn ch\u1ee9ng ph\u1ed5 bi\u1ebfn sau ph\u1eabu thu\u1eadt tim, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong c\u00e1c ca ph\u1eabu thu\u1eadt \u0111\u00f2i h\u1ecfi s\u1eed d\u1ee5ng m\u00e1y tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3. T\u0103ng CO2 m\u00e1u c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn c\u01a1 th\u1ec3, bao g\u1ed3m \u0111au \u0111\u1ea7u, ch\u00f3ng m\u1eb7t, bu\u1ed3n n\u00f4n, kh\u00f3 th\u1edf v\u00e0 th\u1eadm ch\u00ed l\u00e0 g\u00e2y t\u1eed vong. Do \u0111\u00f3, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb t\u0103ng CO2 m\u00e1u sau ph\u1eabu thu\u1eadt tim l\u00e0 r\u1ea5t quan tr\u1ecdng.<\/p>\n<h2><strong>2.\u0110\u1eb7c \u0111i\u1ec3m nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf gi\u1ea3m CO2 m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c:<\/strong><\/h2>\n<h3>2.1 PaCO2 trong kh\u00ed m\u00e1u th\u1ea5p nh\u1eb9 (PCO2 t\u1eeb 30-35 mmHg):<\/h3>\n<p>L\u00e0 kh\u00e1 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c trong giai \u0111o\u1ea1n sau ph\u1eabu thu\u1eadt, \u0111\u1eb7c bi\u1ec7t khi b\u1ec7nh nh\u00e2n b\u1ecb h\u1ea1 th\u00e2n nhi\u1ec7t. N\u00f3 t\u1ea1o ra m\u1ed9t t\u00ecnh tr\u1ea1ng ki\u1ec1m h\u00f4 h\u1ea5p nh\u1eb9 gi\u00fap:<\/p>\n<ul>\n<li>Gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n<li>Cho ph\u00e9p s\u1ea3n xu\u1ea5t CO2 t\u0103ng l\u00ean t\u1eeb t\u1ed1c \u0111\u1ed9 trao \u0111\u1ed5i ch\u1ea5t t\u0103ng cao li\u00ean quan \u0111\u1ebfn vi\u1ec7c l\u00e0m n\u00f3ng v\u00e0 run r\u1ea9y m\u00e0 kh\u00f4ng g\u00e2y ra t\u00ecnh tr\u1ea1ng toan h\u00f4 h\u1ea5p. T\u1ed1c \u0111\u1ed9 trao \u0111\u1ed5i ch\u1ea5t gi\u1ea3m \u0111i 10% cho m\u1ed7i \u0111\u1ed9 d\u01b0\u1edbi 37 \u00b0C, v\u00e0 h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n tr\u1edf l\u1ea1i ph\u00f2ng ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t t\u1eeb ph\u00f2ng m\u1ed5 v\u1edbi nhi\u1ec7t \u0111\u1ed9 quanh 35-36 \u00b0C.<\/li>\n<li>B\u00f9 tr\u1eeb cho t\u00ecnh tr\u1ea1ng toan h\u00f3a nh\u1eb9 th\u01b0\u1eddng x\u1ea3y ra khi thi\u1ebfu m\u00e1u v\u00e0 co th\u1eaft m\u1ea1ch m\u00e1u ngo\u1ea1i vi khi b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n h\u1ea1 th\u00e2n nhi\u1ec7t.<\/li>\n<\/ul>\n<h3>2.2 PaCO2 trong kh\u00ed m\u00e1u t\u0103ng cao:<\/h3>\n<p>C\u00f3 th\u1ec3 g\u00e2y h\u1ea1i v\u00e0 ph\u1ea3i tr\u00e1nh, d\u01b0\u1edbi \u0111\u00e2y l\u00e0 c\u00e1c \u1ea3nh h\u01b0\u1edfng th\u01b0\u1eddng g\u1eb7p ph\u1ea3i:<\/p>\n<ul>\n<li>N\u00f3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng h\u1ea1 kali m\u00e1u v\u00e0 c\u00f3 th\u1ec3 g\u00e2y lo\u1ea1n nh\u1ecbp tim.<\/li>\n<li>PaCO2 trong m\u00e1u cao l\u00e0m d\u1ecbch chuy\u1ec3n \u0111\u01b0\u1eddng cong oxy-hemoglobin sang b\u00ean tr\u00e1i, l\u00e0m gi\u1ea3m l\u01b0\u1ee3ng oxy \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng ra cho c\u00e1c m\u00f4.<\/li>\n<li>N\u00f3 k\u00edch th\u00edch co th\u1eaft m\u1ea1ch m\u00e1u n\u00e3o, l\u00e0m gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn n\u00e3o t\u1eeb \u0111\u00f3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 th\u1ea7n kinh.<\/li>\n<\/ul>\n<h2><strong>3.\u0110i\u1ec1u tr\u1ecb gi\u1ea3m CO2 m\u00e1u:<\/strong><\/h2>\n<p>Quan tr\u1ecdng l\u00e0 \u0111\u00e1nh gi\u00e1 s\u1ef1 th\u00f4ng kh\u00ed v\u00e0 oxy h\u00f3a tr\u01b0\u1edbc v\u00e0 \u0111\u1ea3m b\u1ea3o kh\u00f4ng c\u00f3 v\u1ea5n \u0111\u1ec1 ph\u1ed5i- m\u00e0ng ph\u1ed5i (t\u1eafc ngh\u1ebdn d\u1ecbch nh\u1ea7y, co th\u1eaft ph\u1ebf qu\u1ea3n, c\u0103ng ph\u1ed5i) ho\u1eb7c v\u1ea5n \u0111\u1ec1 t\u1eeb m\u00e1y th\u1edf.<\/p>\n<ul>\n<li>Thi\u1ebft l\u1eadp l\u1ea1i c\u00e0i \u0111\u1eb7t c\u1ee7a m\u00e1y th\u1edf \u0111\u1ec3 t\u0103ng l\u01b0u l\u01b0\u1ee3ng kh\u00ed h\u00edt v\u00e0o ho\u1eb7c t\u0103ng th\u1eddi gian gi\u1eefa cu\u1ed1i\u00a0 th\u00ec th\u1edf ra v\u1edbi m\u1ed9t kho\u1ea3ng th\u1edf sau khi h\u00edt v\u00e0o.<\/li>\n<li>N\u1ebfu kh\u00f4ng th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c v\u1ea5n \u0111\u1ec1 c\u1ee5 th\u1ec3, c\u00f3 th\u1ec3 c\u1ea7n s\u1eed d\u1ee5ng th\u00eam\u00a0 an th\u1ea7n ho\u1eb7c l\u1ef1a ch\u1ecdn thu\u1ed1c kh\u00e1c (propofol, fentanyl ho\u1eb7c dexmedetomidine)<\/li>\n<li>Sau \u0111\u00f3, h\u00f4 h\u1ea5p s\u1ebd \u0111\u01b0\u1ee3c kh\u00f4i ph\u1ee5c trong ch\u1ebf \u0111\u1ed9 h\u1ed7 tr\u1ee3 th\u1edf th\u00f4ng kh\u00ed b\u1eaft bu\u1ed9c li\u00ean t\u1ee5c(CMV). M\u1ee9c PEEP n\u00ean gi\u1ea3m xu\u1ed1ng d\u01b0\u1edbi 5 cm H2O n\u1ebfu PaO2 cho ph\u00e9p.<\/li>\n<li>H\u1ed7 tr\u1ee3 th\u1edf b\u1eb1ng ph\u01b0\u01a1ng th\u1ee9c h\u1ed7 tr\u1ee3 \u00e1p l\u1ef1c mode (PSV) t\u0103ng s\u1ef1 tho\u1ea3i m\u00e1i cho b\u1ec7nh nh\u00e2n t\u1ef1 th\u1edf v\u00e0 c\u00f3 th\u1ec3 gi\u1ea3m c\u00f4ng s\u1ee9c h\u00f4 h\u1ea5p:<\/li>\n<\/ul>\n<p>C\u1ea3i thi\u1ec7n s\u1ef1 ph\u00f9 h\u1ee3p gi\u1eefa l\u01b0u l\u01b0\u1ee3ng kh\u00ed v\u00e0 l\u01b0\u1ee3ng kh\u00ed trao \u0111\u1ed5i \u0111\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 trao \u0111\u1ed5i kh\u00ed. N\u00f3 c\u0169ng gi\u1ea3m c\u00f4ng h\u00f4 h\u1ea5p \u1edf b\u1ec7nh nh\u00e2n khi \u0111\u01b0\u1ee3c an th\u1ea7n v\u00e0\/ho\u1eb7c b\u1ecb li\u1ec7t. Vi\u1ec7c ng\u1eebng h\u1ed7 tr\u1ee3 th\u00f4ng kh\u00ed n\u00ean \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u ngay khi c\u00f3 th\u1ec3\u00a0 \u0111\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a h\u1ed7 tr\u1ee3 th\u00f4ng kh\u00ed k\u00e9o d\u00e0i g\u00f3p ph\u1ea7n v\u00e0o t\u1ef7 l\u1ec7 t\u1eed vong cao. C\u00e1c bi\u1ebfn ch\u1ee9ng n\u00e0y bao g\u1ed3m:<\/p>\n<ul>\n<li>T\u00e1c \u0111\u1ed9ng \u0111\u1ebfn ph\u1ed5i (ph\u00f9 ph\u1ed5i, t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i c\u1ea5p, vi\u00eam ph\u1ed5i li\u00ean quan \u0111\u1ebfn th\u1edf), suy c\u01a1 h\u00f4 h\u1ea5p, y\u1ebfu c\u01a1 h\u00f4 h\u1ea5p (\u0111a th\u1ea7n kinh).<\/li>\n<li>R\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng: t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, gi\u1ea3m huy\u1ebft \u00e1p, t\u0103ng kh\u1ed1i l\u01b0\u1ee3ng m\u00e1u quay v\u1ec1 tim.<\/li>\n<li>V\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a: lo\u00e9t d\u1ea1 d\u00e0y, gi\u1ea3m nhu \u0111\u1ed9ng ru\u1ed9t v\u00e0 kh\u00f3 ch\u1ecbu khi \u0103n qua \u1ed1ng, suy gi\u1ea3m tu\u1ea7n ho\u00e0n ru\u1ed9t, kh\u00f3 kh\u0103n khi nu\u1ed1t sau khi r\u00fat \u1ed1ng th\u00f4ng kh\u00ed.<\/li>\n<li>Ch\u1ee9c n\u0103ng th\u1eadn.<\/li>\n<li>T\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd.<\/li>\n<li>R\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7 v\u00e0 h\u00f4n m\u00ea.<\/li>\n<li>Ph\u00e1t tri\u1ec3n vi\u00eam t\u1eafc t\u0129nh m\u1ea1ch do s\u1eed d\u1ee5ng heparin \u0111\u1ec3 ph\u00f2ng ng\u1eeba huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u.<\/li>\n<\/ul>\n<h2><strong>4.T\u1ed5ng k\u1ebft v\u1ec1 gi\u1ea3m CO2 m\u00e1u.<\/strong><\/h2>\n<p>Gi\u1ea3m CO2 m\u00e1u l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng c\u1ea7n \u0111\u01b0\u1ee3c quan t\u00e2m trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c sau ph\u1eabu thu\u1eadt tim. Vi\u1ec7c gi\u1ea3m CO2 m\u00e1u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u01b0 suy tim, r\u1ed1i lo\u1ea1n nh\u1ecbp tim v\u00e0 suy h\u00f4 h\u1ea5p. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p\u00a0 bao g\u1ed3m t\u0103ng l\u01b0u l\u01b0\u1ee3ng kh\u00ed l\u01b0u th\u00f4ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, s\u1eed d\u1ee5ng c\u00e1c thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p nh\u01b0 m\u00e1y th\u1edf t\u1ea1o \u00e1p l\u1ef1c d\u01b0\u01a1ng (CPAP) ho\u1eb7c m\u00e1y th\u1edf h\u1ed7 tr\u1ee3 \u00e1p l\u1ef1c d\u01b0\u01a1ng (BiPAP)&#8230;<\/p>\n<p>T\u1ed5ng k\u1ebft l\u1ea1i, l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng v\u00e0 \u0111\u00f2i h\u1ecfi s\u1ef1 c\u1ea9n tr\u1ecdng v\u00e0 kinh nghi\u1ec7m c\u1ee7a c\u00e1c chuy\u00ean gia y t\u1ebf. S\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p s\u1ebd gi\u00fap t\u0103ng \u0111\u1ed9 hi\u1ec7u qu\u1ea3 v\u00e0 gi\u1ea3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng v\u00e0 t\u00ednh to\u00e1n \u0111\u1ea7y \u0111\u1ee7 s\u1ebd gi\u00fap c\u00e1c chuy\u00ean gia y t\u1ebf c\u00f3 th\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb t\u1ed1t nh\u1ea5t cho b\u1ec7nh nh\u00e2n v\u00e0 gi\u00fap t\u0103ng c\u01a1 h\u1ed9i h\u1ed3i ph\u1ee5c cho b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim.<\/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<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Gi\u1ea3m CO2 m\u00e1u l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng trong qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n th\u1edf m\u00e1y. Vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh t\u1ea7n s\u1ed1 h\u00f4 h\u1ea5p v\u00e0 th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng l\u00e0 m\u1ed9t trong nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m CO2 m\u00e1u. \u0110\u1ed3ng th\u1eddi, \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng c\u1ee7a s\u1ef1 th\u00f4ng kh\u00ed v\u00e0 oxy h\u00f3a, ki\u1ec3m [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":19951,"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>\u0110i\u1ec1u tr\u1ecb gi\u1ea3m CO2 m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb gi\u1ea3m CO2 m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p . 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