{"id":17960,"date":"2023-04-12T19:35:01","date_gmt":"2023-04-12T12:35:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=17960"},"modified":"2023-04-19T12:21:53","modified_gmt":"2023-04-19T05:21:53","slug":"dieu-tri-tang-co2-mau-tren-benh-nhan-hoi-suc-phau-thuat-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/dieu-tri-tang-co2-mau-tren-benh-nhan-hoi-suc-phau-thuat-tim\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb t\u0103ng CO2 m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim"},"content":{"rendered":"

T\u0103ng CO2 m\u00e1u cho th\u1ea5y l\u01b0\u1ee3ng th\u00f4ng kh\u00ed \u0111\u01b0\u1ee3c cung c\u1ea5p b\u1edfi m\u00e1y th\u1edf kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u1ee7 nhu c\u1ea7u th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n. Vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh c\u00e1c thi\u1ebft l\u1eadp c\u1ee7a m\u00e1y th\u1edf ph\u1ea3i \u0111\u00e1p \u1ee9ng s\u1ef1 t\u0103ng d\u1ea7n c\u1ee7a PCO2 trong giai \u0111o\u1ea1n sau ph\u1eabu thu\u1eadt khi t\u1ef7 l\u1ec7 trao \u0111\u1ed5i ch\u1ea5t t\u0103ng l\u00ean do s\u1ef1 \u1ea5m l\u00ean v\u00e0 co gi\u1eadt sau g\u00e2y m\u00ea.<\/strong><\/p>\n

1.\u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u0103ng CO2 m\u00e1u<\/strong><\/h2>\n

Trong qu\u00e1 tr\u00ecnh r\u00fat \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, m\u1ed9t m\u1ee9c \u0111\u1ed9 PCO2 h\u01a1i cao trong kho\u1ea3ng 48-50 mmHg th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn, v\u00ec b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi thu\u1ed1c an th\u1ea7n. M\u1ee9c \u0111\u1ed9 PCO2 cao h\u01a1n th\u01b0\u1eddng cho th\u1ea5y b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u1ee7 t\u1ec9nh \u0111\u1ec3 duy tr\u00ec th\u00f4ng kh\u00ed \u0111\u1ee7. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y, vi\u1ec7c t\u0103ng t\u1ea7n s\u1ed1 h\u00f4 h\u1ea5p l\u00e0 t\u1ed1t h\u01a1n l\u00e0 t\u0103ng th\u1ec3 t\u00edch kh\u00ed\u00a0 l\u01b0u th\u00f4ng \u0111\u1ec3 b\u00f9 \u0111\u1eafp cho s\u1ef1 t\u0103ng PCO2.<\/p>\n

2. \u0110\u1eb7c \u0111i\u1ec3m s\u00e0ng t\u0103ng CO2 m\u00e1u<\/strong><\/h2>\n

Bi\u1ec3u hi\u1ec7n bao g\u1ed3m nh\u1ecbp tim nhanh, t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, t\u0103ng huy\u1ebft \u00e1p v\u00e0 lo\u1ea1n nh\u1ecbp.<\/p>\n

3.\u0110i\u1ec1u tr\u1ecb t\u0103ng CO2 m\u00e1u<\/strong><\/h2>\n
    \n
  • T\u0103ng CO2 m\u00e1u m\u1ee9c trung b\u00ecnh \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u1edf m\u00e1y \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh b\u1eb1ng c\u00e1ch t\u0103ng t\u1ea7n s\u1ed1 h\u00f4 h\u1ea5p ho\u1eb7c th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng.<\/li>\n
  • T\u0103ng CO2 \u0111\u00e1ng k\u1ec3 th\u01b0\u1eddng cho th\u1ea5y c\u00f3 v\u1ea5n \u0111\u1ec1 c\u01a1 h\u1ecdc, ch\u1eb3ng h\u1ea1n nh\u01b0 l\u1ed7i m\u00e1y th\u1edf, v\u1ecb tr\u00ed \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n b\u1ea5t th\u01b0\u1eddng ho\u1eb7c kh\u00ed ph\u1ebf th\u1ee7ng. V\u1ea5n \u0111\u1ec1 n\u00e0y \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft l\u00e0 \u0111i\u1ec1u ch\u1ec9nh c\u00e1c thi\u1ebft l\u1eadp c\u1ee7a m\u00e1y th\u1edf, \u0111i\u1ec1u ch\u1ec9nh l\u1ea1i v\u1ecb tr\u00ed c\u1ee7a \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n.<\/li>\n
  • Thu\u1ed1c an th\u1ea7n c\u00f3 th\u1eddi gian t\u00e1c d\u1ee5ng ng\u1eafn ho\u1eb7c c\u00e1c thu\u1ed1c an th\u1ea7n kh\u00e1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng an th\u1ea7n. C\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y bao g\u1ed3m:<\/li>\n<\/ul>\n
      \n
    1. \u00a0Propofol 25-75 \u03bcg\/kg\/ph\u00fat .<\/li>\n
    2. Morphine sulfate 2.5-5 mg IV q1-2h.<\/li>\n
    3. Fentanyl c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng khi c\u1ea7n t\u00ecnh tr\u1ea1ng an th\u1ea7n k\u00e9o d\u00e0i h\u01a1n. Li\u1ec1u th\u00f4ng th\u01b0\u1eddng l\u00e0 50-100 \u03bcg IV trong v\u00f2ng n\u0103m ph\u00fat, v\u1edbi c\u00e1c li\u1ec1u ti\u1ebfp theo m\u1ed7i hai gi\u1edd theo nhu c\u1ea7u.<\/li>\n
    4. Midazolam 2-4 mg IV q1h ho\u1eb7c 2-10 mg\/h nh\u01b0 m\u1ed9t li\u1ec1u ti\u00eam li\u00ean t\u1ee5c th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng c\u00f9ng v\u1edbi fentanyl.<\/li>\n<\/ol>\n

      \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0m ch\u1eadm qu\u00e1 tr\u00ecnh r\u00fat \u1ed1ng th\u00f4ng kh\u00ed. Co gi\u1eadt n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t nh\u1ea5t b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng meperidine 25-50 mg IV ho\u1eb7c dexmedetomidine.<\/p>\n

      N\u1ebfu b\u1ec7nh nh\u00e2n t\u0103ng CO2 m\u00e1u do “ch\u1ed1ng l\u1ea1i m\u00e1y th\u1edf” v\u00e0 kh\u00f4ng nh\u1eadn \u0111\u01b0\u1ee3c th\u1ec3 t\u00edch kh\u00ed th\u1edf \u0111\u1ea7y \u0111\u1ee7, c\u00e1c b\u01b0\u1edbc\u00a0 g\u1ed3m thay \u0111\u1ed5i thi\u1ebft l\u1eadp c\u1ee7a m\u00e1y th\u1edf, s\u1eed d\u1ee5ng thu\u1ed1c an th\u1ea7n v\u00e0 chuy\u1ec3n sang mode PSV-th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o h\u1ed7 tr\u1ee3 \u00e1p l\u1ef1c s\u1ebd\u00a0 c\u1ea3i thi\u1ec7n qu\u00e1 tr\u00ecnh th\u00f4ng kh\u00ed.<\/p>\n

      S\u1eed d\u1ee5ng mode PSV:<\/strong><\/p>\n

      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

        \n
      • 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
      • 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
      • 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
      • Ch\u1ee9c n\u0103ng th\u1eadn.<\/li>\n
      • T\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd. Bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 g\u1eb7p khi th\u1edf mode PSV l\u00e0 l\u00e0m \u00e1p l\u1ef1c n\u1ed9i s\u1ecd t\u0103ng l\u00ean g\u00e2y nguy hi\u1ec3m cho t\u00ednh m\u1ea1ng.<\/li>\n
      • R\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7 v\u00e0 h\u00f4n m\u00ea.<\/li>\n
      • 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

        4.K\u1ebft lu\u1eadn v\u00e0 t\u1ed5ng k\u1ebft<\/strong><\/h2>\n

        Vi\u1ec7c t\u0103ng CO2 m\u00e1u \u1edf b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c sau ph\u1eabu thu\u1eadt tim l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. T\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n nh\u1ecbp tim, suy tim v\u00e0 suy h\u00f4 h\u1ea5p, g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng \u0111\u00e1ng ng\u1ea1i cho b\u1ec7nh nh\u00e2n. Hi\u1ec3u r\u00f5 nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf t\u0103ng CO2 m\u00e1u l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u01b0a ra ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3.<\/p>\n

        Theo nghi\u00ean c\u1ee9u c\u1ee7a T\u1ea1p ch\u00ed Y khoa New England, nguy\u00ean nh\u00e2n ch\u00ednh c\u1ee7a t\u00ecnh tr\u1ea1ng t\u0103ng CO2 m\u00e1u trong b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c sau ph\u1eabu thu\u1eadt tim l\u00e0 do r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p. Kh\u00f4ng \u0111\u1ee7 l\u01b0u l\u01b0\u1ee3ng kh\u00ed l\u01b0u th\u00f4ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng n\u00e0y. B\u00ean c\u1ea1nh \u0111\u00f3, s\u1eed d\u1ee5ng n\u1ed3ng \u0111\u1ed9 oxy cao c\u0169ng l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u0103ng CO2 m\u00e1u.<\/p>\n

        \u0110\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u00ecnh tr\u1ea1ng t\u0103ng CO2 m\u00e1u, c\u00e1c chuy\u00ean gia y t\u1ebf \u0111\u00e3 \u0111\u01b0a ra c\u00e1c ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 t\u0103ng l\u01b0u l\u01b0\u1ee3ng kh\u00ed l\u01b0u th\u00f4ng, s\u1eed d\u1ee5ng 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) \u0111\u1ec3 gi\u1ea3m CO2 m\u00e1u v\u00e0 \u0111i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p.<\/p>\n

        Tuy nhi\u00ean, \u0111\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m, c\u00e1c chuy\u00ean gia y t\u1ebf c\u1ea7n s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p. V\u00ed d\u1ee5 nh\u01b0 k\u1ebft h\u1ee3p t\u0103ng l\u01b0u l\u01b0\u1ee3ng kh\u00ed l\u01b0u th\u00f4ng v\u1edbi s\u1eed d\u1ee5ng m\u00e1y th\u1edf t\u1ea1o \u00e1p l\u1ef1c d\u01b0\u01a1ng, ho\u1eb7c k\u1ebft h\u1ee3p s\u1eed d\u1ee5ng thu\u1ed1c v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c 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.<\/p>\n

        T\u1ed5ng k\u1ebft l\u1ea1i,\u00a0 l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng trong th\u1ef1c h\u00e0nh y khoa. Vi\u1ec7c 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. C\u00e1c chuy\u00ean gia y t\u1ebf c\u1ea7n ti\u1ebfp t\u1ee5c nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb m\u1edbi \u0111\u1ec3 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n","protected":false},"excerpt":{"rendered":"

        T\u0103ng CO2 m\u00e1u cho th\u1ea5y l\u01b0\u1ee3ng th\u00f4ng kh\u00ed \u0111\u01b0\u1ee3c cung c\u1ea5p b\u1edfi m\u00e1y th\u1edf kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u1ee7 nhu c\u1ea7u th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n. Vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh c\u00e1c thi\u1ebft l\u1eadp c\u1ee7a m\u00e1y th\u1edf ph\u1ea3i \u0111\u00e1p \u1ee9ng s\u1ef1 t\u0103ng d\u1ea7n c\u1ee7a PCO2 trong giai \u0111o\u1ea1n sau ph\u1eabu thu\u1eadt khi t\u1ef7 l\u1ec7 trao \u0111\u1ed5i ch\u1ea5t t\u0103ng l\u00ean […]<\/p>\n","protected":false},"author":7,"featured_media":20163,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\n\u0110i\u1ec1u tr\u1ecb t\u0103ng CO2 m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb t\u0103ng CO2 m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim l\u00e0 v\u1ea5n \u0111\u1ec1 quan trong. Tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y \u0111\u1ec3 c\u00f3 c\u00e1ch nh\u00ecn t\u1ed5ng quan,\" \/>\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=\"\u0110i\u1ec1u tr\u1ecb t\u0103ng CO2 m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim\" \/>\n<meta property=\"og:description\" content=\"\u0110i\u1ec1u tr\u1ecb t\u0103ng CO2 m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c ph\u1eabu thu\u1eadt tim l\u00e0 v\u1ea5n \u0111\u1ec1 quan trong. 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