{"id":19441,"date":"2023-04-14T21:05:16","date_gmt":"2023-04-14T14:05:16","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19441"},"modified":"2023-04-25T11:38:13","modified_gmt":"2023-04-25T04:38:13","slug":"ke-hoach-ra-vien-tren-benh-nhan-sau-phau-thuat-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/ke-hoach-ra-vien-tren-benh-nhan-sau-phau-thuat-tim\/","title":{"rendered":"K\u1ebf ho\u1ea1ch ra vi\u1ec7n tr\u00ean b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim"},"content":{"rendered":"

Ph\u1eabu thu\u1eadt tim<\/a> k\u1ef9 thu\u1eadt \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd tim \u0111\u1eb7c bi\u1ec7t, do \u0111\u00f3 sau th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1ea1m \u1ed5n, k\u1ebf ho\u1ea1ch xu\u1ea5t vi\u1ec7n ph\u00f9 h\u1ee3p l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i sau khi xu\u1ea5t vi\u1ec7n. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u1ea7n ch\u0103m s\u00f3c ph\u1ee5c h\u1ed3i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ebfn c\u00e1c b\u1ec7nh vi\u1ec7n ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng ho\u1eb7c c\u01a1 s\u1edf ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t \u0111\u1ec3 \u1edf v\u00e0i ng\u00e0y tr\u01b0\u1edbc khi v\u1ec1 nh\u00e0. <\/strong><\/p>\n

1. K\u1ebf ho\u1ea1ch xu\u1ea5t vi\u1ec7n <\/strong><\/h2>\n

N\u00ean bao g\u1ed3m b\u1ec7nh nh\u00e2n, c\u00e1c th\u00e0nh vi\u00ean trong gia \u0111\u00ecnh, nh\u00e2n vi\u00ean ch\u0103m s\u00f3c v\u00e0 b\u00e1c s\u0129. B\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn r\u00f5 r\u00e0ng v\u1ec1 c\u1ea3m gi\u00e1c c\u1ee7a h\u1ecd sau xu\u1ea5t vi\u1ec7n, t\u1ed1c \u0111\u1ed9 ph\u1ee5c h\u1ed3i c\u00f3 th\u1ec3 k\u1ef3 v\u1ecdng, nh\u1eefng g\u00ec h\u1ecd kh\u00f4ng \u0111\u01b0\u1ee3c l\u00e0m, nh\u1eefng g\u00ec h\u1ecd n\u00ean t\u00ecm ki\u1ebfm v\u00e0 khi n\u00e0o li\u00ean l\u1ea1c v\u1edbi b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb ho\u1eb7c c\u1ea7n \u0111\u1ebfn b\u1ec7nh vi\u1ec7n. C\u00f3 nhi\u1ec1u t\u00e0i li\u1ec7u h\u01b0\u1edbng d\u1eabn c\u00f3 s\u1eb5n \u0111\u1ec3 tham kh\u1ea3o v\u1ec1 k\u1ebf ho\u1ea1ch xu\u1ea5t vi\u1ec7n.<\/p>\n

2. Thu\u1ed1c. <\/strong><\/h2>\n

B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c bi\u1ebft v\u1ec1 c\u00e1c lo\u1ea1i v\u00e0 c\u00e1ch d\u00f9ng c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c lo\u1ea1i thu\u1ed1c c\u0169ng nh\u01b0 t\u00e1c d\u1ee5ng ph\u1ee5 c\u00f3 th\u1ec3 x\u1ea3y ra v\u00e0 t\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c. N\u1ebfu b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng nh\u01b0 warfarin, th\u00ec vi\u1ec7c theo d\u00f5i prothrombin times (INR) v\u00e0 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c l\u00e0 ho\u00e0n to\u00e0n c\u1ea7n thi\u1ebft. T\u00e1c d\u1ee5ng kh\u00f4ng t\u1ed1t c\u1ee7a r\u01b0\u1ee3u, c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c v\u00e0 m\u1ed9t s\u1ed1 lo\u1ea1i th\u1ef1c ph\u1ea9m \u0111\u1ed1i v\u1edbi m\u1ee9c \u0111\u1ed9 ch\u1ed1ng \u0111\u00f4ng c\u0169ng nh\u01b0 t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c nh\u1ea5n m\u1ea1nh.<\/p>\n

2.1. <\/span>Aspirin:<\/span><\/span><\/h3>\n

\u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh (CABG), kh\u00f4ng ch\u1ec9 \u0111\u1ec3 ng\u1eeba huy\u1ebft kh\u1ed1i tr\u00ean m\u1ea1ch m\u00e1u \u0111\u01b0\u1ee3c b\u1eafc c\u1ea7u m\u00e0 c\u00f2n \u0111\u1ec3 ph\u00f2ng ng\u1eeba t\u1eafc c\u00e1c \u0111\u1ed9ng m\u1ea1ch v\u00e0nh ph\u1ee5. Aspirin \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong sau CABG. N\u00f3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ri\u00eang ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi Anti-Vitamin K cho b\u1ec7nh nh\u00e2n thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 nh\u00e2n t\u1ea1o.<\/p>\n

2.2 Ch\u1ea5t \u1ee9c ch\u1ebf P2Y12<\/h3>\n

G\u1ed3m (clopidogrel, ticagrelor v\u00e0 prasugrel) n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t k\u00e8m v\u1edbi aspirin \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n tr\u1ea3i qua CABG trong tr\u01b0\u1eddng h\u1ee3p h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p ho\u1eb7c sau ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u tim \u0111\u1eadp (OPCAB).<\/p>\n

2.3. Nh\u1eefng lo\u1ea1i thu\u1ed1c l\u00e0m gi\u1ea3m ho\u1ea1t t\u00ednh kh\u00e1ng ti\u1ec3u c\u1ea7u c\u1ee7a clopidogrel bao g\u1ed3m:<\/h3>\n

Omeprazole (nh\u01b0ng kh\u00f4ng ph\u1ea3i pantoprazole), morphine v\u00e0 amlodipine (kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi ticagrelor).<\/p>\n

2.4. Nh\u1eefng lo\u1ea1i thu\u1ed1c l\u00e0m t\u0103ng ho\u1ea1t t\u00ednh kh\u00e1ng ti\u1ec3u c\u1ea7u c\u1ee7a clopidogrel bao g\u1ed3m:<\/h3>\n

Aspirin v\u00e0 c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf men chuy\u1ec3n (ACE).<\/p>\n

2.5. Anti-Vitamin K( Acenocoumarol)<\/h3>\n

\u0110\u01b0\u1ee3c k\u00ea \u0111\u01a1n cho b\u1ec7nh nh\u00e2n rung nh\u0129, van nh\u00e2n t\u1ea1o c\u01a1 h\u1ecdc v\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n thay van sinh h\u1ecdc<\/p>\n

2.6. <\/span>Statin<\/span><\/span><\/h3>\n

\u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh do t\u00e1c d\u1ee5ng gi\u1ea3m lipid.Statin c\u00f3 th\u1ec3 l\u00e0m \u1ed5n \u0111\u1ecbnh m\u1ea3ng b\u00e1m. Ch\u00fang \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 ng\u1eafn h\u1ea1n v\u00e0 d\u00e0i h\u1ea1n c\u1ee7a CABG v\u00e0 th\u1eadm ch\u00ed c\u1ea3 ph\u1eabu thu\u1eadt van tim. T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n d\u00f9ng statin n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra ch\u1ee9c n\u0103ng gan t\u1ea1i th\u1eddi \u0111i\u1ec3m kh\u1edfi \u0111\u1ea7u v\u00e0 sau 6 th\u00e1ng. C\u00e1c lo\u1ea1i statin m\u1ea1nh do gi\u1ea3m >= 50% LDL-c ban \u0111\u1ea7u (atorvastatin 40-80 mg ho\u1eb7c rosuvastatin 20-40 mg) \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb sau CABG \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 75 tu\u1ed5i, v\u1edbi li\u1ec1u trung b\u00ecnh. C\u00e1c li\u1ec1u d\u00f9ng c\u1ee7a thu\u1ed1c c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng b\u1edfi t\u01b0\u01a1ng t\u00e1c thu\u1ed1c-thu\u1ed1c v\u00e0 c\u00f3 th\u1ec3 c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u ho\u1eb7c kh\u00f4ng \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n cho nh\u1eefng b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i.<\/p>\n

    \n
  • Simvastatin c\u00f3 t\u01b0\u01a1ng t\u00e1c \u0111\u00e1ng k\u1ec3 v\u1edbi amiodarone, amlodipine, diltiazem v\u00e0 ticagrelor. Kh\u00f4ng n\u00ean d\u00f9ng qu\u00e1 10 mg simvastatin cho b\u1ec7nh nh\u00e2n d\u00f9ng verapamil ho\u1eb7c diltiazem v\u00e0 kh\u00f4ng n\u00ean d\u00f9ng qu\u00e1 20 mg simvastatin cho b\u1ec7nh nh\u00e2n d\u00f9ng amiodarone ho\u1eb7c amlodipine.<\/li>\n
  • Atorvastatin c\u00f3 t\u01b0\u01a1ng t\u00e1c \u0111\u00e1ng k\u1ec3 v\u1edbi digoxin, diltiazem v\u00e0 verapamil. Kh\u00f4ng n\u00ean d\u00f9ng qu\u00e1 40 mg atorvastatin cho b\u1ec7nh nh\u00e2n d\u00f9ng diltiazem.<\/li>\n<\/ul>\n

    2.7. \u03b2-blocker ( ch\u1eb9n beta):<\/h3>\n

    \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n sau CABG \u0111\u1ec3 ph\u00f2ng ng\u1eeba rung nh\u0129 trong giai \u0111o\u1ea1n xung quanh ph\u1eabu thu\u1eadt, nh\u01b0ng n\u00f3 c\u0169ng c\u00f3 l\u1ee3i \u00edch v\u1ec1 t\u1ef7 l\u1ec7 s\u1ed1ng cho b\u1ec7nh nh\u00e2n sau c\u01a1n nh\u1ed3i m\u00e1u tim \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ho\u1eb7c tr\u1ea3i qua CABG v\u00e0 cho c\u00e1c b\u1ec7nh nh\u00e2n kh\u00e1c c\u00f3 ch\u1ee9c n\u0103ng t\u00e2m th\u1ea5t suy gi\u1ea3m ho\u1eb7c suy tim. C\u00f3 m\u1ed9t s\u1ed1 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y ch\u00fang c\u0169ng c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng d\u00e0i h\u1ea1n cho b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p hay suy tim. Carvedilol th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ee9c n\u0103ng t\u00e2m th\u1ea5t suy gi\u1ea3m. N\u1ebfu kh\u00f4ng c\u00f3 v\u1ea5n \u0111\u1ec1 g\u00ec v\u1ec1 ch\u1ee9c n\u0103ng t\u00e2m th\u1ea5t, metoprolol l\u00e0 thu\u1ed1c \u03b2-blocker \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 c\u00f3 l\u1ee3i cho vi\u1ec7c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p.<\/p>\n

    2.8. <\/span>Amiodaron<\/span><\/span><\/h3>\n

    C\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba rung nh\u0129, tuy nhi\u00ean th\u1eddi gian \u0111i\u1ec1u tr\u1ecb l\u00fd t\u01b0\u1edfng ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. N\u1ebfu b\u1ec7nh nh\u00e2n v\u1eabn \u1edf trong nh\u1ecbp xoang, thu\u1ed1c th\u01b0\u1eddng c\u00f3 th\u1ec3 ng\u01b0ng sau v\u00e0i tu\u1ea7n. N\u00f3 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng trong v\u00e0i th\u00e1ng sau khi th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt Cox-Maze. Amiodarone c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng gan, tuy\u1ebfn gi\u00e1p v\u00e0 ph\u1ed5i, v\u00ec v\u1eady b\u1ea5t k\u1ef3 b\u1ec7nh nh\u00e2n n\u00e0o \u0111\u01b0\u1ee3c d\u1ef1 ki\u1ebfn s\u1eed d\u1ee5ng thu\u1ed1c trong h\u01a1n m\u1ed9t th\u00e1ng n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ki\u1ec3m tra ch\u1ee9c n\u0103ng gan, x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p v\u00e0 \u0111\u00e1nh gi\u00e1 ph\u1ed5i \u1edf l\u1ea7n kh\u00e1m s\u1ee9c kh\u1ecfe \u0111\u1ea7u ti\u00ean.Nh\u1eefng v\u1ea5n \u0111\u1ec1 \u0111\u1eb7c bi\u1ec7t c\u1ea7n quan t\u00e2m \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim m\u1ea1ch l\u00e0 amiodarone:<\/p>\n

      \n
    • Gi\u1ea3m s\u1ef1 trao \u0111\u1ed5i ch\u1ea5t c\u1ee7a warfarin, \u0111\u00f2i h\u1ecfi gi\u1ea3m li\u1ec1u warfarin 25\u201350%<\/li>\n
    • Hi\u1ebfm khi g\u00e2y gi\u1ea3m \u1ee9c ch\u1ebf ti\u1ec3u c\u1ea7u b\u1edfi clopidogrel<\/li>\n
    • T\u0103ng th\u1eddi gian k\u00e9o d\u00e0i QT khi s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi fluoroquinolones (ciprofloxacin, levofloxacin), ch\u1ea5t \u0111\u1ed1i kh\u00e1ng 5-HT3 (ondansetron) ho\u1eb7c haloperidol. Nh\u1eefng lo\u1ea1i thu\u1ed1c n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o kh\u00f4ng s\u1eed d\u1ee5ng n\u1ebfu \u0111ang s\u1eed d\u1ee5ng amiodarone.<\/li>\n
    • T\u0103ng c\u01b0\u1eddng t\u00e1c d\u1ee5ng gi\u1ea3m nh\u1ecbp tim ch\u1eadm khi s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi \u03b2-blocker ho\u1eb7c Calcium channel blocker (CCB).<\/li>\n<\/ul>\n

      2.9 \u1ee8c ch\u1ebf men chuy\u1ec3n (Inhibitor ACE )(ho\u1eb7c ARB n\u1ebfu kh\u00f4ng dung \u0111\u01b0\u1ee3c inhibtor ACE)<\/h3>\n

      \u0110\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 lo\u1ea1i thu\u1ed1c ch\u1ed1ng t\u0103ng huy\u1ebft \u00e1p \u01b0u ti\u00ean sau ph\u1eabu thu\u1eadt v\u00e0 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ee9c n\u0103ng t\u00e2m th\u1ea5t suy gi\u1ea3m <40%, ti\u1ec1n s\u1eed nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c B\u1ec7nh th\u1eadn m\u1ea1n(CKD). M\u1eb7c d\u00f9 kh\u00f4ng c\u00f3 s\u1ef1 c\u1ea3i thi\u1ec7n v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong ng\u1eafn h\u1ea1n \u0111\u01b0\u1ee3c ch\u1ee9ng minh, inhibtor ACE c\u00f3 th\u1ec3 cung c\u1ea5p l\u1ee3i \u00edch v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong d\u00e0i h\u1ea1n.<\/p>\n

      3. Kh\u00e1ng sinh ph\u00f2ng ng\u1eeba. <\/strong><\/h2>\n

      B\u1ea5t k\u1ef3 b\u1ec7nh nh\u00e2n n\u00e0o c\u00f3 van tim nh\u00e2n t\u1ea1o ph\u1ea3i bi\u1ebft v\u1ec1 s\u1ef1 c\u1ea7n thi\u1ebft c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh ph\u00f2ng ng\u1eeba n\u1ebfu d\u1ef1 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb r\u0103ng mi\u1ec7ng.<\/p>\n

      4. B\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng <\/strong><\/h2>\n

      Li\u00ean quan \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng cao h\u01a1n sau ph\u1eabu thu\u1eadt CABG v\u00e0 vi\u1ec7c ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft k\u00e9m sau ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u1ed9 b\u1ec1n c\u1ee7a van tim nh\u00e2n t\u1ea1o v\u00e0 g\u00f3p ph\u1ea7n v\u00e0o s\u1ef1 ti\u1ebfn tri\u1ec3n nhanh ch\u00f3ng h\u01a1n c\u1ee7a b\u1ec7nh m\u1ea1ch m\u00e1u \u0111\u1ed9ng m\u1ea1ch. Ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng v\u00e0 thu\u1ed1c n\u00ean \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u h\u00f3a \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c HbA1c <7%.<\/p>\n

      5. Ch\u1ebf \u0111\u1ed9 \u0103n v\u00e0 luy\u1ec7n t\u1eadp: <\/strong><\/h2>\n
        \n
      • Ch\u1ebf \u0111\u1ed9 \u0103n \u00edt cholesterol ho\u1eb7c \u0103n \u00edt mu\u1ed1i v\u00e0 cung c\u1ea5p c\u00e1c k\u1ebf ho\u1ea1ch \u0103n u\u1ed1ng ph\u00f9 h\u1ee3p l\u00e0 c\u1ea7n thi\u1ebft.<\/li>\n
      • B\u1ec7nh nh\u00e2n ph\u1ea3i t\u1ef1 \u0111\u00e1nh gi\u00e1 t\u1ea1i nh\u00e0. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 m\u1ed7i ng\u00e0y v\u1ec1 nh\u1ecbp tim, nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 v\u00e0 c\u00e2n n\u1eb7ng c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n, v\u00e0 t\u1ea5t c\u1ea3 c\u00e1c v\u1ebft m\u1ed5 n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra xem c\u00f3 s\u1ef1 \u0111\u1ecf, \u0111au ho\u1eb7c ch\u1ea3y d\u1ecbch hay kh\u00f4ng.<\/li>\n
      • B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch t\u0103ng d\u1ea7n ho\u1ea1t \u0111\u1ed9ng c\u1ee7a m\u00ecnh theo s\u1ef1 ch\u1ecbu \u0111\u1ef1ng \u0111\u01b0\u1ee3c. B\u1ec7nh nh\u00e2n c\u00f3 v\u1ebft m\u1ed5 ph\u1ea7n tr\u01b0\u1edbc c\u1ee7a ng\u1ef1c th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch n\u00e2ng v\u1eadt n\u1eb7ng h\u01a1n 5kg, v\u00ec \u0111i\u1ec1u n\u00e0y g\u00e2y c\u0103ng x\u01b0\u01a1ng ng\u1ef1c \u0111ang l\u00e0nh. L\u00e1i xe n\u00ean tr\u00e1nh trong s\u00e1u tu\u1ea7n.<\/li>\n
      • Thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 ki\u1ec3m so\u00e1t t\u1ea5t c\u1ea3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u00f3 th\u1ec3 thay \u0111\u1ed5i l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a k\u1ebft qu\u1ea3 d\u00e0i h\u1ea1n c\u1ee7a ph\u1eabu thu\u1eadt. \u0110i\u1ec1u n\u00e0y bao g\u1ed3m gi\u1ea3m c\u00e2n, ng\u1eebng h\u00fat thu\u1ed1c v\u00e0 ki\u1ec3m so\u00e1t r\u1ed1i lo\u1ea1n lipid, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 t\u0103ng huy\u1ebft \u00e1p. Tr\u1ea7m c\u1ea3m sau ph\u1eabu thu\u1eadt kh\u00f4ng hi\u1ebfm v\u00e0 n\u00ean \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb v\u00ec n\u00f3 li\u00ean quan \u0111\u1ebfn ch\u1eadm ph\u1ee5c h\u1ed3i. Tham gia ch\u01b0\u01a1ng tr\u00ecnh ph\u1ee5c h\u1ed3i tim m\u1ea1ch l\u00e0 m\u1ed9t ph\u1ea7n quan tr\u1ecdng c\u1ee7a ch\u0103m s\u00f3c d\u00e0i h\u1ea1n sau ph\u1eabu thu\u1eadt.<\/li>\n<\/ul>\n

         <\/p>\n","protected":false},"excerpt":{"rendered":"

        Ph\u1eabu thu\u1eadt tim k\u1ef9 thu\u1eadt \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd tim \u0111\u1eb7c bi\u1ec7t, do \u0111\u00f3 sau th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1ea1m \u1ed5n, k\u1ebf ho\u1ea1ch xu\u1ea5t vi\u1ec7n ph\u00f9 h\u1ee3p l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i sau khi xu\u1ea5t vi\u1ec7n. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u1ea7n ch\u0103m s\u00f3c ph\u1ee5c h\u1ed3i c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ebfn […]<\/p>\n","protected":false},"author":7,"featured_media":20054,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nK\u1ebf ho\u1ea1ch ra vi\u1ec7n tr\u00ean b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim - Vinmec<\/title>\n<meta name=\"description\" content=\"Xu\u1ea5t vi\u1ec7n sau ph\u1eabu thu\u1eadt tim l\u00e0 v\u1ea5n \u0111\u1ec1 quan t\u00e2m sau th\u1eddi gian \u0111i\u1ec1u tr\u1ecb. 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