{"id":19712,"date":"2023-04-16T18:20:50","date_gmt":"2023-04-16T11:20:50","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19712"},"modified":"2023-04-17T12:19:56","modified_gmt":"2023-04-17T05:19:56","slug":"chi-dinh-va-tien-luong-benh-nhan-sau-ghep-phoi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/chi-dinh-va-tien-luong-benh-nhan-sau-ghep-phoi\/","title":{"rendered":"Ch\u1ec9 \u0111\u1ecbnh v\u00e0 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n sau gh\u00e9p ph\u1ed5i"},"content":{"rendered":"<p><strong>Gh\u00e9p ph\u1ed5i l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n m\u1eafc c\u00e1c b\u1ec7nh ph\u1ed5i nghi\u00eam tr\u1ecdng, bao g\u1ed3m b\u1ec7nh ph\u1ed5i k\u1ebd, suy h\u00f4 h\u1ea5p m\u1ea1n t\u00ednh, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh(COPD), &#8230; Gh\u00e9p ph\u1ed5i c\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n b\u1eb1ng c\u00e1ch gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh ph\u1ed5i nghi\u00eam tr\u1ecdng v\u00e0 mang l\u1ea1i kh\u1ea3 n\u0103ng h\u00f4 h\u1ea5p t\u1ed1i \u01b0u. \u0110\u00e2y l\u00e0 h\u01b0\u1edbng ph\u00e1t tri\u1ec3n c\u00f3 nhi\u1ec1u ti\u1ec1m n\u0103ng trong t\u01b0\u01a1ng lai.<\/strong><\/p>\n<h2>1. T\u1ed5ng quan v\u1ec1 gh\u00e9p ph\u1ed5i<\/h2>\n<p>Gh\u00e9p ph\u1ed5i\u00a0l\u00e0 m\u1ed9t lo\u1ea1i gh\u00e9p t\u1ea1ng, l\u00e0 gi\u1ea3i ph\u00e1p \u0111i\u1ec1u tr\u1ecb d\u00e0nh cho nhi\u1ec1u b\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh giai \u0111o\u1ea1n cu\u1ed1i, khi kh\u00f4ng th\u1ec3 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c. Ng\u01b0\u1eddi cho t\u1ea1ng c\u00f3 th\u1ec3 l\u00e0 ng\u01b0\u1eddi cho s\u1ed1ng\u00a0&#8211; hi\u1ebfn m\u1ed9t ph\u1ea7n t\u1ea1ng c\u1ee7a h\u1ecd (th\u00f9y gan, th\u00f9y ph\u1ed5i) hay 1 trong 2 t\u1ea1ng (th\u1eadn), nh\u01b0ng \u0111a s\u1ed1 l\u00e0\u00a0ng\u01b0\u1eddi cho ch\u1ebft n\u00e3o,\u00a0th\u01b0\u1eddng hi\u1ebfn nhi\u1ec1u t\u1ea1ng &#8211; g\u1ecdi l\u00e0\u00a0ng\u01b0\u1eddi cho \u0111a t\u1ea1ng ch\u1ebft n\u00e3o.<\/p>\n<p>Gh\u00e9p ph\u1ed5i thu\u1ed9c lo\u1ea1i gh\u00e9p t\u1ea1ng ph\u1ee9c t\u1ea1p nh\u1ea5t g\u1ed3m: gh\u00e9p 1 ph\u1ed5i, gh\u00e9p 2 ph\u1ed5i, gh\u00e9p th\u00f9y ph\u1ed5i, gh\u00e9p ph\u1ed5i t\u1eeb ng\u01b0\u1eddi cho ch\u1ebft n\u00e3o, t\u1eeb ng\u01b0\u1eddi cho s\u1ed1ng, gh\u00e9p ph\u1ed5i v\u00e0 tim; trong \u0111\u00f3 ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 k\u1ef9 thu\u1eadt gh\u00e9p 2 ph\u1ed5i t\u1eeb ng\u01b0\u1eddi cho \u0111a t\u1ea1ng ch\u1ebft n\u00e3o. \u1ede Vi\u1ec7t Nam, gh\u00e9p ph\u1ed5i v\u1eabn trong giai \u0111o\u1ea1n kh\u1edfi \u0111\u1ed9ng, t\u1eeb th\u00e1ng 9\/2020 \u0111\u1ebfn cu\u1ed1i n\u0103m 2021 \u0111\u00e3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c 8 ca gh\u00e9p hai ph\u1ed5i, trong \u0111\u00f3 c\u00f3 7\/8 ca gh\u00e9p t\u1eeb ng\u01b0\u1eddi cho ch\u1ebft n\u00e3o v\u00e0 c\u00f3 1 ca b\u1ec7nh ph\u1ed5i k\u1ebd.<\/p>\n<figure id=\"attachment_21095\" aria-describedby=\"caption-attachment-21095\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-21095 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-883985472-612x612-1-300x195.jpg\" alt=\"Gh\u00e9p ph\u1ed5i\u00a0\u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nhi\u1ec1u b\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh giai \u0111o\u1ea1n cu\u1ed1i.\" width=\"300\" height=\"195\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-883985472-612x612-1-300x195.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/istockphoto-883985472-612x612-1.jpg 612w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-21095\" class=\"wp-caption-text\">Gh\u00e9p ph\u1ed5i\u00a0\u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nhi\u1ec1u b\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh giai \u0111o\u1ea1n cu\u1ed1i.<\/figcaption><\/figure>\n<h2>2. Ch\u1ec9 \u0111\u1ecbnh gh\u00e9p ph\u1ed5i<\/h2>\n<p>Ti\u00eau chu\u1ea9n ng\u01b0\u1eddi nh\u1eadn ph\u1ed5i theo h\u01b0\u1edbng d\u1eabn c\u1ee7a h\u1ed9i gh\u00e9p tim ph\u1ed5i qu\u1ed1c t\u1ebf (ISHLT):<\/p>\n<h3>2.1. C\u00f3 ch\u1ec9 \u0111\u1ecbnh gh\u00e9p ph\u1ed5i<\/h3>\n<ul>\n<li>B\u1ec7nh c\u0103n: g\u1ed3m 80 b\u1ec7nh chia theo 4 nh\u00f3m. Chi\u1ebfm t\u1edbi 95% g\u1ed3m COPD, IPF, x\u01a1 nang ph\u1ed5i, gi\u00e3n ph\u1ebf nang do thi\u1ebfu h\u1ee5t alpha 1 antitrypsin, v\u00e0 TAL\u0110PM.<\/li>\n<li>M\u1ee9c \u0111\u1ed9 b\u1ec7nh ph\u1ed5i n\u1eb7ng, kh\u00f4ng \u0111\u00e1p \u1ee9ng ho\u1eb7c kh\u00f4ng c\u00f2n gi\u1ea3i ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa, nguy c\u01a1 t\u1eed vong &gt; 50% trong v\u00f2ng 2 n\u0103m (theo LAS &#8211; Lung Allocation Score).<\/li>\n<li>Ti\u00ean l\u01b0\u1ee3ng tr\u00ean 80% s\u1ed1ng \u0111\u01b0\u1ee3c \u2265 90 ng\u00e0y sau gh\u00e9p. Kh\u00f4ng c\u00f3 b\u1ec7nh ngo\u00e0i ph\u1ed5i c\u00f3 nguy c\u01a1 t\u1eed vong trong 5 n\u0103m. Kh\u00f4ng c\u00f3 c\u00e1c v\u1ea5n \u0111\u1ec1 t\u00e2m l\u00fd x\u00e3 h\u1ed9i, v\u00e0 \u0111\u01b0\u1ee3c tr\u1ee3 gi\u00fap \u0111\u1ea7y \u0111\u1ee7.<\/li>\n<\/ul>\n<h3>2.2. Kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 lo\u1ea1i b\u1ec7nh n\u00e0o trong c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i sau:<\/h3>\n<ul>\n<li>Nhi\u1ec5m tr\u00f9ng ph\u1ed5i, ngo\u00e0i ph\u1ed5i &#8211; ch\u01b0a \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t; Lao \u0111ang ho\u1ea1t \u0111\u1ed9ng;<\/li>\n<li>B\u1ec7nh \u00e1c t\u00ednh m\u1edbi ph\u00e1t hi\u1ec7n 2 n\u0103m; Suy n\u1eb7ng ch\u1ee9c n\u0103ng c\u00e1c c\u01a1 quan kh\u00e1c (tim, gan, th\u1eadn, n\u00e3o);<\/li>\n<li>B\u1ec7nh m\u1ea1ch v\u00e0nh n\u1eb7ng;<\/li>\n<li>R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u kh\u00f4ng \u0111i\u1ec1u ch\u1ec9nh \u0111\u01b0\u1ee3c;<\/li>\n<li>D\u1ecb d\u1ea1ng c\u1ed9t s\u1ed1ng &#8211; l\u1ed3ng ng\u1ef1c n\u1eb7ng; BMI \u2265 35 kg\/m2;<\/li>\n<li>\u0110ang h\u00fat thu\u1ed1c l\u00e1;<\/li>\n<li>Nghi\u1ec7n r\u01b0\u1ee3u ho\u1eb7c thu\u1ed1c g\u00e2y nghi\u1ec7n;<\/li>\n<li>C\u00e1c v\u1ea5n \u0111\u1ec1 t\u00e2m l\u00fd x\u00e3 h\u1ed9i ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, ho\u1eb7c kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ul>\n<h3>2.3. Ch\u1ec9 c\u00f3 1 &#8211; 2 lo\u1ea1i trong c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i:<\/h3>\n<ul>\n<li>Tu\u1ed5i&gt; 65 tu\u1ed5i;<\/li>\n<li>BMI = 30 &#8211; 34.9 kg\/m2;<\/li>\n<li>Suy dinh d\u01b0\u1ee1ng n\u1eb7ng;<\/li>\n<li>Lo\u00e3ng x\u01b0\u01a1ng n\u1eb7ng &#8211; c\u00f3 tri\u1ec7u ch\u1ee9ng;<\/li>\n<li>Ti\u1ec1n s\u1eed ph\u1eabu thu\u1eadt c\u1eaft ph\u1ed5i;<\/li>\n<li>Nhi\u1ec5m khu\u1ea9n, n\u1ea5m c\u00f3 kh\u1ea3 n\u0103ng kh\u00e1ng thu\u1ed1c cao;<\/li>\n<li>Nhi\u1ec5m HIV;<\/li>\n<li>\u0110ang nhi\u1ec5m HBV, ho\u1eb7c HCV;<\/li>\n<li>Kh\u00f4ng c\u00f3 h\u1ed7 tr\u1ee3 x\u00e3 h\u1ed9i.<\/li>\n<\/ul>\n<h3>2.4. Tu\u1ed5i\u00a0t\u1eeb 15 &#8211; 60 tu\u1ed5i; \u0110\u00e3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa \u0111\u1ea7y \u0111\u1ee7 ch\u1ed1ng nhi\u1ec5m tr\u00f9ng ph\u1ed5i (n\u1ebfu c\u00f3).<\/h3>\n<h3>2.5.\u00a0 Kh\u00f4ng c\u00f3 th\u00eam c\u00e1c y\u1ebfu t\u1ed1 b\u1ea5t l\u1ee3i\u00a0sau:<\/h3>\n<ul>\n<li>T\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng kh\u00f4ng t\u1ed1t t\u1ea1i th\u1eddi \u0111i\u1ec3m gh\u00e9p (huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh, th\u1edf m\u00e1y x\u00e2m nh\u1eadp ho\u1eb7c ECMO &#8211; ch\u01b0a \u0111\u01b0\u1ee3c th\u0103m d\u00f2 \u0111\u1ea7y \u0111\u1ee7 \u0111\u1ec3 gh\u00e9p ph\u1ed5i);<\/li>\n<li>\u0110ang d\u00f9ng corticoid li\u1ec1u cao; Ti\u1ec3u \u0111\u01b0\u1eddng ho\u1eb7c lo\u00e3ng x\u01b0\u01a1ng n\u1eb7ng;<\/li>\n<li>\u0110ang m\u1eafc b\u1ec7nh n\u1eb7ng \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a (lo\u00e9t, vi\u00eam, xu\u1ea5t huy\u1ebft).<\/li>\n<\/ul>\n<h2>3. Ti\u00ean l\u01b0\u1ee3ng sau gh\u00e9p ph\u1ed5i<\/h2>\n<ul>\n<li>T\u1ef7 l\u1ec7 th\u1ea3i gh\u00e9p c\u1ea5p t\u00ednh ph\u1ed5 bi\u1ebfn trong n\u0103m \u0111\u1ea7u ti\u00ean sau gh\u00e9p ph\u1ed5i, kho\u1ea3ng 30-40% c\u00f3 \u00edt nh\u1ea5t m\u1ed9t \u0111\u1ee3t trong n\u0103m \u0111\u1ea7u ti\u00ean sau gh\u00e9p.<\/li>\n<li>R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ph\u1ed5i gh\u00e9p nguy\u00ean ph\u00e1t l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y t\u1eed vong trong v\u00f2ng 30 ng\u00e0y \u0111\u1ea7u, v\u00e0 b\u1ec7nh ph\u1ed5i k\u1ebd l\u00e0 nh\u00f3m b\u1ec7nh c\u00f3 kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t sau gh\u00e9p ph\u1ed5i k\u00e9m nh\u1ea5t trong c\u00e1c b\u1ec7nh ph\u1ed5i.<\/li>\n<li>Tuy nhi\u00ean, gh\u00e9p ph\u1ed5i v\u1eabn l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb r\u1ea5t c\u00f3 \u00fd ngh\u0129a cho nh\u1eefng NB b\u1ecb b\u1ec7nh ph\u1ed5i k\u1ebd sau khi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa th\u1ea5t b\u1ea1i, v\u00ec t\u1ea1o ra m\u1ed9t c\u01a1 h\u1ed9i s\u1ed1ng s\u00f3t v\u00e0 n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng cho ng\u01b0\u1eddi b\u1ec7nh.<\/li>\n<li>Th\u1ed1ng k\u00ea c\u1ee7a ISHLT cho th\u1ea5y nh\u1eefng ng\u01b0\u1eddi \u0111\u01b0\u1ee3c gh\u00e9p ph\u1ed5i c\u00f3 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng, s\u1ee9c kh\u1ecfe chung t\u1ed1t h\u01a1n v\u00e0 nhi\u1ec1u ng\u01b0\u1eddi th\u1eadm ch\u00ed c\u00f3 th\u1ec3 tr\u1edf l\u1ea1i l\u00e0m vi\u1ec7c. C\u00f3 t\u1edbi 30% NB \u0111ang l\u00e0m vi\u1ec7c sau 1 n\u0103m v\u00e0 50% \u0111ang l\u00e0m vi\u1ec7c sau 5 n\u0103m Tuy nhi\u00ean, gh\u00e9p ph\u1ed5i c\u00f2n c\u00f3 nhi\u1ec1u r\u1ee7i ro v\u00e0 nh\u1eadn th\u1ee9c c\u1ee7a NB v\u1ec1 nh\u1eefng r\u1ee7i ro n\u00e0y l\u00e0 r\u1ea5t quan tr\u1ecdng tr\u01b0\u1edbc khi gh\u00e9p ph\u1ed5i, c\u1ea7n \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch v\u00e0 chia s\u1ebb v\u1edbi NB. C\u1ea7n l\u00e0m t\u1ea5t c\u1ea3 c\u00e1c bi\u1ec7n ph\u00e1p th\u00edch h\u1ee3p \u0111\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 xung quanh vi\u1ec7c gh\u00e9p ph\u1ed5i, t\u1eeb \u0111\u00f3 c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 l\u00e2u d\u00e0i.<\/li>\n<\/ul>\n<p>Gh\u00e9p ph\u1ed5i c\u00f3 th\u1ec3 c\u1ee9u s\u1ed1ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a nh\u1eefng ng\u01b0\u1eddi m\u1eafc c\u00e1c b\u1ec7nh ph\u1ed5i n\u1eb7ng m\u00e0 kh\u00f4ng th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p truy\u1ec1n th\u1ed1ng. Tuy nhi\u00ean, vi\u1ec7c th\u1ef1c hi\u1ec7n gh\u00e9p ph\u1ed5i c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi c\u00e1c chuy\u00ean gia y t\u1ebf c\u00f3 kinh nghi\u1ec7m v\u00e0 b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd sau khi gh\u00e9p \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 th\u00e0nh c\u00f4ng c\u1ee7a ph\u1eabu thu\u1eadt v\u00e0 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea3y ra.<\/p>\n<p>Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n<p><iframe loading=\"lazy\" title=\"Ung th\u01b0 ph\u1ed5i giai \u0111o\u1ea1n mu\u1ed9n \u2013 ch\u01b0a ph\u1ea3i d\u1ea5u ch\u1ea5m h\u1ebft!| BS L\u00ea T\u1ea5n \u0110\u1ea1t, BV Vinmec Central Park\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/lqbNEIvkYZo?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Gh\u00e9p ph\u1ed5i l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n m\u1eafc c\u00e1c b\u1ec7nh ph\u1ed5i nghi\u00eam tr\u1ecdng, bao g\u1ed3m b\u1ec7nh ph\u1ed5i k\u1ebd, suy h\u00f4 h\u1ea5p m\u1ea1n t\u00ednh, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh(COPD), &#8230; Gh\u00e9p ph\u1ed5i c\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n b\u1eb1ng c\u00e1ch gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ch\u1ec9 \u0111\u1ecbnh v\u00e0 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n sau gh\u00e9p ph\u1ed5i - Vinmec<\/title>\n<meta name=\"description\" content=\"Gh\u00e9p ph\u1ed5i\u00a0l\u00e0 m\u1ed9t lo\u1ea1i gh\u00e9p t\u1ea1ng, l\u00e0 gi\u1ea3i ph\u00e1p \u0111i\u1ec1u tr\u1ecb d\u00e0nh cho nhi\u1ec1u b\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh giai \u0111o\u1ea1n cu\u1ed1i. 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