{"id":21168,"date":"2023-04-16T08:34:44","date_gmt":"2023-04-16T01:34:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21168"},"modified":"2023-05-07T05:53:18","modified_gmt":"2023-05-06T22:53:18","slug":"nhom-i","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/nhom-i\/","title":{"rendered":"T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i nh\u00f3m I : C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb chung"},"content":{"rendered":"<p><strong>T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i nh\u00f3m I (Pulmonary arterial hypertension &#8211; PAH group I) l\u00e0 m\u1ed9t lo\u1ea1i b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u ph\u1ed5i \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u0103ng \u00e1p l\u1ef1c trong c\u00e1c m\u1ea1ch m\u00e1u ph\u1ed5i do t\u1eafc ngh\u1ebdn ho\u1eb7c co th\u1eaft \u1edf m\u1ea1ch m\u00e1u ph\u1ed5i. \u0110\u00e2y l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nghi\u00eam tr\u1ecdng v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7y \u0111\u1ee7 \u0111\u1ec3 gi\u1ea3m thi\u1ec3u bi\u1ebfn ch\u1ee9ng v\u00e0 n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb chung cho t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1edfi nh\u00f3m I c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb trong v\u00e0i t\u00ecnh hu\u1ed1ng \u0111\u1eb7c\u00a0 bi\u1ec7t k\u00e8m theo.<\/strong><\/p>\n<h1><strong>1. C\u00e1c \u0111i\u1ec1u tr\u1ecb chung PAH nh\u00f3m I<\/strong><\/h1>\n<p><strong>\u00a0 \u00a0 \u00a0 <img decoding=\"async\" loading=\"lazy\" class=\"aligncenter wp-image-32379\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1-14.png\" alt=\"\" width=\"665\" height=\"361\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1-14.png 545w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1-14-300x163.png 300w\" sizes=\"(max-width: 665px) 100vw, 665px\" \/> \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 <\/strong><\/p>\n<p><strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Ngu\u1ed3n<\/strong>: <em>German Heart Center<\/em><\/p>\n<h3><strong>1.1. Ho\u1ea1t \u0111\u1ed9ng th\u1ec3 thao v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng.<\/strong><\/h3>\n<p>Theo ESC\/ERS 2015 v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p ph\u1ed5i \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i n\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch ho\u1ea1t \u0111\u1ed9ng trong gi\u1edbi h\u1ea1n c\u1ee7a b\u1ea3n th\u00e2n. K\u1ec3 t\u1eeb \u0111\u00f3, c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c \u0111\u00e3 ch\u1ec9 ra t\u00e1c \u0111\u1ed9ng c\u00f3 l\u1ee3i c\u1ee7a vi\u1ec7c t\u1eadp luy\u1ec7n th\u1ec3 d\u1ee5c \u0111\u1ed1i v\u1edbi kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.<\/p>\n<h3><strong>1.2. Kh\u00e1ng \u0111\u00f4ng trong PAH nh\u00f3m I.<\/strong><\/h3>\n<p>C\u00f3 m\u1ed9t s\u1ed1 l\u00fd do \u0111\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng kh\u00e1ng \u0111\u00f4ng \u1edf b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n<p>C\u00e1c m\u1eabu m\u00f4 b\u1ec7nh h\u1ecdc t\u1eeb ph\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i cho th\u1ea5y huy\u1ebft kh\u1ed1i t\u1ea1i ch\u1ed7 c\u1ee7a c\u00e1c m\u1ea1ch ph\u1ed5i.<\/p>\n<p>B\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh m\u1ea1ch v\u00e0nh ho\u1eb7c ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n huy\u1ebft kh\u1ed1i \u1edf \u0111\u1ed9ng m\u1ea1ch trung t\u00e2m.<\/p>\n<p>Nh\u1eefng b\u1ea5t th\u01b0\u1eddng trong h\u1ec7 th\u1ed1ng \u0111\u00f4ng m\u00e1u v\u00e0 ti\u00eau s\u1ee3i huy\u1ebft cho th\u1ea5y t\u00ecnh tr\u1ea1ng ti\u1ec1n \u0111\u00f4ng m\u00e1u \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n<p>Nh\u01b0ng nh\u1eefng qu\u00e1 tr\u00ecnh n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c.<\/p>\n<p>M\u1eb7c d\u00f9 thi\u1ebfu b\u1eb1ng ch\u1ee9ng, c\u00e1c d\u1eef li\u1ec7u thu \u0111\u01b0\u1ee3c t\u1eeb n\u0103m 2007 \u0111\u1ebfn 2016 cho th\u1ea5y thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf 43% b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00f4 c\u0103n.<\/p>\n<p>Trong t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i li\u00ean quan \u0111\u1ebfn x\u01a1 c\u1ee9ng h\u1ec7 th\u1ed1ng, c\u00e1c d\u1eef li\u1ec7u nghi\u00ean c\u1ee9u v\u00e0 ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p \u0111\u1ec1u ch\u1ec9 ra r\u1eb1ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u c\u00f3 th\u1ec3 c\u00f3 h\u1ea1i.<\/p>\n<p>Trong tim b\u1ea9m sinh, kh\u00f4ng c\u00f3 c\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean v\u1ec1 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u. C\u0169ng kh\u00f4ng c\u00f3 s\u1ef1 \u0111\u1ed3ng thu\u1eadn v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch d\u00e0i h\u1ea1n khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c ch\u1ea5t t\u01b0\u01a1ng t\u01b0 Prostacyclin.<\/p>\n<p>V\u00ec thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u v\u00e0 trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u ch\u1eafc ch\u1eafn, kh\u00f4ng c\u00f3 khuy\u1ebfn c\u00e1o chung n\u00e0o \u0111\u01b0\u1ee3c \u0111\u01b0a ra v\u1ec1 vi\u1ec7c n\u00ean hay kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u1edf b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. Do \u0111\u00f3, vi\u1ec7c ra quy\u1ebft \u0111\u1ecbnh s\u1ebd theo quan \u0111i\u1ec3m \u0111i\u1ec1u tr\u1ecb c\u1ee7a m\u1ed7i c\u00e1 nh\u00e2n.<\/p>\n<h3><strong>1.3. L\u1ee3i ti\u1ec3u trong PAH nh\u00f3m I.<\/strong><\/h3>\n<p>Tr\u00e1nh qu\u00e1 t\u1ea3i d\u1ecbch l\u00e0 m\u1ed9t trong nh\u1eefng m\u1ee5c ti\u00eau ch\u00ednh trong vi\u1ec7c qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p ph\u1ed5i. M\u1ed9t khi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a suy tim b\u00ean ph\u1ea3i v\u00e0 ph\u00f9, n\u00ean h\u1ea1n ch\u1ebf l\u01b0\u1ee3ng d\u1ecbch \u0111\u01b0a v\u00e0o v\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u.<\/p>\n<p>Ba nh\u00f3m thu\u1ed1c l\u1ee3i ti\u1ec3u ch\u00ednh l\u00e0 \u00a0l\u1ee3i ti\u1ec3u quai, l\u1ee3i ti\u1ec3u Thiazide v\u00e0 \u00a0\u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 mineralocorticoid, \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u01a1n tr\u1ecb li\u1ec7u ho\u1eb7c k\u1ebft h\u1ee3p, t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng v\u00e0 ch\u1ee9c n\u0103ng th\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<p>B\u1ec7nh nh\u00e2n c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u n\u00ean \u0111\u01b0\u1ee3c th\u01b0\u1eddng xuy\u00ean theo d\u00f5i tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 v\u00e0 t\u01b0 v\u1ea5n trong tr\u01b0\u1eddng h\u1ee3p t\u0103ng c\u00e2n. Ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 c\u00e1c ch\u1ea5t \u0111i\u1ec7n gi\u1ea3i trong huy\u1ebft thanh n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i th\u01b0\u1eddng xuy\u00ean, v\u00e0 ph\u1ea3i tr\u00e1nh gi\u1ea3m th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch v\u00ec n\u00f3 c\u00f3 th\u1ec3 g\u00e2y ra \u00a0gi\u1ea3m th\u00eam CO2 v\u00e0 huy\u1ebft \u00e1p h\u1ec7 th\u1ed1ng.<\/p>\n<p>N\u00ean nh\u1edb r\u1eb1ng qu\u00e1 t\u1ea3i d\u1ecbch v\u00e0 ph\u00f9 c\u00f3 th\u1ec3 kh\u00f4ng nh\u1ea5t thi\u1ebft l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a suy tim ph\u1ea3i, v\u00ec \u0111i\u1ec1u \u0111\u00f3 c\u0169ng c\u00f3 th\u1ec3 l\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n<h3><strong>1.4. Oxy li\u1ec7u ph\u00e1p trong PAH nh\u00f3m I.<\/strong><\/h3>\n<p>M\u1eb7c d\u00f9 s\u1eed d\u1ee5ng oxy l\u00e0m gi\u1ea3m kh\u00e1ng tr\u1edf v\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c \u1edf b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, nh\u01b0ng kh\u00f4ng c\u00f3 nghi\u00ean c\u1ee9u n\u00e0o cho th\u1ea5y li\u1ec7u ph\u00e1p oxy d\u00e0i h\u1ea1n mang l\u1ea1i l\u1ee3i \u00edch l\u00e2u d\u00e0i trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1ec7nh.<\/p>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 nghi\u00ean c\u1ee9u ch\u1eafc ch\u1eafn v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng oxy \u1edf b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i th\u00ec ch\u1ec9 \u0111\u1ecbnh th\u1edf Oxy\u00a0 khi PaO2 &lt; 60 mmHg (ho\u1eb7c SaO2 &lt; 92%).<\/p>\n<p>C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng oxy c\u1ea5p c\u1ee9u khi c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 l\u1ee3i \u00edch \u0111\u1ed1i v\u1edbi tri\u1ec7u ch\u1ee9ng v\u00e0 t\u00ecnh tr\u1ea1ng gi\u1ea3m b\u00e3o h\u00f2a c\u00f3 th\u1ec3 \u0111i\u1ec1u ch\u1ec9nh \u0111\u01b0\u1ee3c khi t\u1eadp th\u1ec3 d\u1ee5c. \u00a0Li\u1ec7u ph\u00e1p oxy ban \u0111\u00eam n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t trong tr\u01b0\u1eddng h\u1ee3p gi\u1ea3m \u0111\u1ed9 b\u00e3o h\u00f2a li\u00ean quan \u0111\u1ebfn gi\u1ea5c ng\u1ee7.<\/p>\n<h3><strong>1.5. Thu\u1ed1c tim m\u1ea1ch trong PAH nh\u00f3m I.<\/strong><\/h3>\n<p>Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1ec1 t\u00ednh h\u1eefu \u00edch v\u00e0 an to\u00e0n c\u1ee7a c\u00e1c lo\u1ea1i thu\u1ed1c c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1utr\u1ecb t\u0103ng huy\u1ebft \u00e1p ho\u1eb7c \u0111i\u1ec1u tr\u1ecb suy tim tr\u00e1i, ch\u1eb3ng h\u1ea1n nh\u01b0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin (ARB), thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin\u2013neprilysin (ARNIs), natri \u2013thu\u1ed1c \u1ee9c ch\u1ebf \u0111\u1ed3ng v\u1eadn chuy\u1ec3n glucose-2 (SGLT-2i), thu\u1ed1c ch\u1eb9n beta ho\u1eb7c Ivabradine \u1edf b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, nh\u1eefng lo\u1ea1i thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn gi\u1ea3m huy\u1ebft \u00e1p, nh\u1ecbp tim ho\u1eb7c c\u1ea3 hai.<\/p>\n<p>Hi\u1ec7u qu\u1ea3 c\u1ee7a digoxin\/digitoxin ch\u01b0a \u0111\u01b0\u1ee3c ghi nh\u1eadn trong t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, m\u1eb7c d\u00f9 nh\u1eefng thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 l\u00e0m ch\u1eadm t\u1ea7n s\u1ed1 th\u1ea5t \u1edf b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i k\u00e8m nh\u1ecbp nhanh nh\u0129.<\/p>\n<h3><strong>1.6. Thi\u1ebfu m\u00e1u v\u00e0 thi\u1ebfu s\u1eaft trong PAH nh\u00f3m I.<\/strong><\/h3>\n<p>Thi\u1ebfu s\u1eaft ph\u1ed5 bi\u1ebfn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh b\u1edfi n\u1ed3ng \u0111\u1ed9 ferritin huy\u1ebft thanh &lt; 100 \u00b5g\/L ho\u1eb7c ferritin huy\u1ebft thanh 100\u2013299 \u00b5g\/L v\u00e0 \u0111\u1ed9 b\u00e3o h\u00f2a transferrin &lt; 20%.<\/p>\n<p>C\u00e1c c\u01a1 ch\u1ebf b\u1ec7nh l\u00fd c\u01a1 b\u1ea3n r\u1ea5t ph\u1ee9c t\u1ea1p. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, thi\u1ebfu s\u1eaft c\u00f3 li\u00ean quan \u0111\u1ebfn suy gi\u1ea3m ch\u1ee9c n\u0103ng c\u01a1 tim, l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 t\u0103ng nguy c\u01a1 t\u1eed vong. D\u1ef1a tr\u00ean nh\u1eefng d\u1eef li\u1ec7u n\u00e0y, n\u00ean theo d\u00f5i th\u01b0\u1eddng xuy\u00ean t\u00ecnh tr\u1ea1ng s\u1eaft (s\u1eaft huy\u1ebft thanh, ferritin, \u0111\u1ed9 b\u00e3o h\u00f2a transferrin, th\u1ee5 th\u1ec3 transferrin h\u00f2a tan).<\/p>\n<p>\u1ede b\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u thi\u1ebfu s\u1eaft n\u1eb7ng (Hb \u2264 7\u20138 g\/dL), truy\u1ec1n t\u0129nh m\u1ea1ch \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. C\u00e1c s\u1eaft c\u00f4ng th\u1ee9c d\u1ea1ng u\u1ed1ng c\u00f3 ch\u1ee9a s\u1eaft (Fe2+) sulfat, s\u1eaft gluconate v\u00e0 s\u1eaft fumarate th\u01b0\u1eddng \u0111\u01b0\u1ee3c dung n\u1ea1p k\u00e9m v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c c\u00f3 th\u1ec3 b\u1ecb suy gi\u1ea3m \u1edf b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. Maltol s\u1eaft l\u00e0 m\u1ed9t c\u00f4ng th\u1ee9c m\u1edbi, c\u00f3 s\u1eb5n qua \u0111\u01b0\u1eddng u\u1ed1ng c\u1ee7a s\u1eaft (Fe3+).<\/p>\n<h3><strong>1.7. Ti\u00eam vaccine.<\/strong><\/h3>\n<p>L\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe t\u1ed5ng qu\u00e1t, b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i n\u00ean \u0111\u01b0\u1ee3c ti\u00eam vaccine \u00edt nh\u1ea5t l\u00e0 vaccine c\u00fam, Streptococcus pneumoniae v\u00e0 SARS-CoV-2.<\/p>\n<h3><strong>1.8. H\u1ed7 tr\u1ee3 t\u00e2m l\u00fd.<\/strong><\/h3>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m v\u00e0 lo l\u1eafng, c\u0169ng nh\u01b0 r\u1ed1i lo\u1ea1n \u0111i\u1ec1u ch\u1ec9nh, c\u00f3 t\u1ef7 l\u1ec7 cao \u1edf b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. T\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u0169ng c\u00f3 t\u00e1c \u0111\u1ed9ng nghi\u00eam tr\u1ecdng \u0111\u1ebfn kh\u1ea3 n\u0103ng l\u00e0m vi\u1ec7c v\u00e0 thu nh\u1eadp.<\/p>\n<p>C\u00e1c c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc ch\u1ea9n \u0111o\u00e1n \u0111\u1ea7y \u0111\u1ee7 l\u00e0 ch\u00eca kh\u00f3a \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 t\u00e2m l\u00fd\/t\u00e2m th\u1ea7n, bao g\u1ed3m thu\u1ed1c t\u00e2m th\u1ea7n, ho\u1eb7c h\u1ed7 tr\u1ee3 x\u00e3 h\u1ed9i.<\/p>\n<h3><strong>1.9. \u00a0S\u1ef1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.<\/strong><\/h3>\n<p>C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng vi\u1ec7c tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1edf b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 th\u1ec3 l\u00e0 d\u01b0\u1edbi m\u1ee9c t\u1ed1i \u01b0u. Do s\u1ef1 ph\u1ee9c t\u1ea1p c\u1ee7a \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ti\u1ec1m \u1ea9n v\u00e0 r\u1ee7i ro li\u00ean quan \u0111\u1ebfn vi\u1ec7c gi\u00e1n \u0111o\u1ea1n \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>\u0110\u1ec3 th\u00fac \u0111\u1ea9y tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i \u0111\u1ea3m b\u1ea3o r\u1eb1ng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c tham gia v\u00e0o c\u00e1c quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u01b0\u1ee3c th\u00f4ng b\u00e1o v\u1ec1 c\u00e1c l\u1ef1a ch\u1ecdn v\u00e0 l\u00fd do \u0111i\u1ec1u tr\u1ecb, k\u1ef3 v\u1ecdng, t\u00e1c d\u1ee5ng ph\u1ee5 v\u00e0 h\u1eadu qu\u1ea3 ti\u1ec1m \u1ea9n c\u1ee7a vi\u1ec7c kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<h2><strong>2. C\u00e1c t\u00ecnh hu\u1ed1ng \u0111\u1eb7c bi\u1ec7t trong PAH nh\u00f3m I<\/strong><\/h2>\n<h3><strong>2.1. Mang thai v\u00e0 ng\u1eeba thai.<\/strong><\/h3>\n<p><strong>2.1.1. Mang thai.<\/strong><\/p>\n<p>H\u01b0\u1edbng d\u1eabn ESC\/ERS tr\u01b0\u1edbc \u0111\u00e2y v\u1ec1 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p ph\u1ed5i \u0111\u00e3 khuy\u1ebfn c\u00e1o r\u1eb1ng b\u1ec7nh nh\u00e2n m\u1eafc t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i n\u00ean tr\u00e1nh mang thai. Tuy nhi\u00ean, c\u00f3 nh\u1eefng b\u00e1o c\u00e1o v\u1ec1 k\u1ebft qu\u1ea3 mang thai thu\u1eadn l\u1ee3i \u1edf ph\u1ee5 n\u1eef m\u1eafc t\u0103ng \u00e1p ph\u1ed5i, bao g\u1ed3m ph\u1ee5 n\u1eef b\u1ecb t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00f4 c\u0103n \u0111\u00e1p \u1ee9ng v\u1edbi li\u1ec7u ph\u00e1p chen Canxi.<\/p>\n<p>B\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh ki\u1ec3m so\u00e1t k\u00e9m, c\u00f3 nguy c\u01a1 trung b\u00ecnh ho\u1eb7c cao v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t ph\u1ea3i, c\u00f3 nguy c\u01a1 cao d\u1eabn \u0111\u1ebfn di\u1ec5n ti\u1ebfn\u00a0 b\u1ea5t l\u1ee3i th\u00ec h\u1ecd n\u00ean \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n c\u1ea9n th\u1eadn v\u00e0 n\u00ean ch\u1ea5m d\u1ee9t thai k\u1ef3 s\u1edbm.<\/p>\n<p>\u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t, c\u00f3 nguy c\u01a1 th\u1ea5p v\u00e0 huy\u1ebft \u0111\u1ed9ng khi ngh\u1ec9 ng\u01a1i b\u00ecnh th\u01b0\u1eddng ho\u1eb7c g\u1ea7n b\u00ecnh th\u01b0\u1eddng \u0111ang c\u00e2n nh\u1eafc mang thai, n\u00ean t\u01b0 v\u1ea5n\u00a0 v\u00e0 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nh\u01b0 v\u1eady, c\u00e1c l\u1ef1a ch\u1ecdn thay th\u1ebf nh\u01b0 nh\u1eadn con nu\u00f4i v\u00e0 mang thai h\u1ed9 c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c kh\u00e1m ph\u00e1.<\/p>\n<p>Li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 th\u1ec3 ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh. N\u00ean ng\u1eebng thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 endothelin (ERA), riociguat v\u00e0 selexipag v\u00ec kh\u1ea3 n\u0103ng g\u00e2y qu\u00e1i thai ho\u1eb7c ch\u01b0a bi\u1ebft. \u00a0M\u1eb7c d\u00f9 b\u1eb1ng ch\u1ee9ng h\u1ea1n ch\u1ebf, chen Canxi, PDE5is, v\u00e0 c\u00e1c ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 prostacyclin d\u1ea1ng h\u00edt\/i.v.\/ti\u00eam d\u01b0\u1edbi da (s.c.) \u0111\u01b0\u1ee3c coi l\u00e0 an to\u00e0n trong thai k\u1ef3.<\/p>\n<p><strong>2.1.2. Ng\u1eeba thai.<\/strong><\/p>\n<p>S\u1eed d\u1ee5ng nhi\u1ec1u h\u00ecnh th\u1ee9c tr\u00e1nh thai, bao g\u1ed3m c\u1ea3 thu\u1ed1c tr\u00e1nh thai mang l\u1ea1i hi\u1ec7u qu\u1ea3 cao. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng bosentan, n\u00ean xem x\u00e9t c\u1ea9n th\u1eadn vi\u1ec7c gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c bi\u1ec7n ph\u00e1p tr\u00e1nh thai n\u1ed9i ti\u1ebft t\u1ed1.<\/p>\n<p>S\u1eed d\u1ee5ng c\u1ea5y gh\u00e9p n\u1ed9i ti\u1ebft t\u1ed1 ho\u1eb7c d\u1ee5ng c\u1ee5 t\u1eed cung l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn thay th\u1ebf v\u1edbi t\u1ef7 l\u1ec7 th\u1ea5t b\u1ea1i th\u1ea5p. Bi\u1ec7n ph\u00e1p tr\u00e1nh thai n\u1ed9i ti\u1ebft sau giao h\u1ee3p kh\u1ea9n c\u1ea5p s\u1ebd an to\u00e0n \u1edf b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p ph\u1ed5i.<\/p>\n<h3><strong>2.2. Ph\u1eabu thu\u1eadt.<\/strong><\/h3>\n<p>C\u00e1c th\u1ee7 thu\u1eadt ph\u1eabu thu\u1eadt \u1edf b\u1ec7nh nh\u00e2n t\u0103ng \u00e1p ph\u1ed5i c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 cao m\u1eafc suy tim ph\u1ea3i v\u00e0 t\u1eed vong.<\/p>\n<p>Quy\u1ebft \u0111\u1ecbnh th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u01b0a ra b\u1edfi s\u1ef1 tham gia li\u00ean khoa ng\u00e0nh c\u00f3 s\u1ef1 tham gia c\u1ee7a b\u00e1c s\u0129 t\u0103ng \u00e1p ph\u1ed5i v\u00e0 ph\u1ea3i d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 r\u1ee7i ro: l\u1ee3i \u00edch c\u00e1 nh\u00e2n khi xem x\u00e9t c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c nhau, bao g\u1ed3m ch\u1ec9 \u0111\u1ecbnh, m\u1ee9c \u0111\u1ed9 kh\u1ea9n c\u1ea5p, m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a t\u0103ng \u00e1p ph\u1ed5i v\u00e0 y\u00eau c\u1ea7u c\u1ee7a b\u1ec7nh nh\u00e2n. Thang \u0111i\u1ec3m r\u1ee7i ro \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n nguy c\u01a1 t\u1eed vong chu ph\u1eabu \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u nh\u01b0ng c\u1ea7n th\u00eam d\u1eef li\u1ec7u.<\/p>\n<p>N\u00ean c\u1ed1 g\u1eafng t\u1ed1i \u01b0u h\u00f3a li\u1ec7u ph\u00e1p t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i tr\u01b0\u1edbc ph\u1eabu thu\u1eadt b\u1ea5t c\u1ee9 khi n\u00e0o c\u00f3 th\u1ec3.<\/p>\n<h3><strong>2.3. Du l\u1ecbch v\u00e0 \u0111\u1ed9 cao.<\/strong><\/h3>\n<p>\u00c1p su\u1ea5t trong khoang m\u00e1y bay t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi \u0111\u1ed9 cao l\u00ean t\u1edbi 2438 m t\u1ea1i \u0111\u00f3 PaO2 gi\u1ea3m xu\u1ed1ng m\u1ee9c c\u1ee7a ph\u1ea7n O2 \u0111\u01b0\u1ee3c h\u00edt v\u00e0o l\u00e0 15,1% tr\u00ean bi\u1ec3n m\u1ee9c \u0111\u1ed9. Tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng cho th\u1ea5y r\u1eb1ng t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy b\u00ecnh th\u01b0\u1eddng ng\u1eafn h\u1ea1n (&lt; 1 ng\u00e0y) th\u01b0\u1eddng \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng v\u1edbi t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n<p>N\u00ean cung c\u1ea5p oxy tr\u00ean m\u00e1y bay cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 PaO2 &lt; 60 mmHg ho\u1eb7c SaO2 &lt; 92%. T\u1ed1c \u0111\u1ed9 d\u00f2ng oxy 2 L\/ph\u00fat s\u1ebd t\u0103ng \u00e1p su\u1ea5t oxy h\u00edt v\u00e0o l\u00ean c\u00e1c gi\u00e1 tr\u1ecb.<\/p>\n<p>Do t\u00e1c \u0111\u1ed9ng c\u1ee7a vi\u1ec7c ti\u1ebfp x\u00fac v\u1edbi t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy t\u1eeb trung b\u00ecnh \u0111\u1ebfn d\u00e0i h\u1ea1n (v\u00e0i gi\u1edd trong 1ng\u00e0y) trong t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i ph\u1ea7n l\u1edbn v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh. B\u1ec7nh nh\u00e2n n\u00ean tr\u00e1nh \u0111\u1ed9 cao 1500 m khi kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ed5 sung oxy.<\/p>\n<p><strong>Ngu\u1ed3n<\/strong>: ESC\/ERS Guidelines for Pulmonary Hypertension 2022<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>T\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i nh\u00f3m I (Pulmonary arterial hypertension &#8211; PAH group I) l\u00e0 m\u1ed9t lo\u1ea1i b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u ph\u1ed5i \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u0103ng \u00e1p l\u1ef1c trong c\u00e1c m\u1ea1ch m\u00e1u ph\u1ed5i do t\u1eafc ngh\u1ebdn ho\u1eb7c co th\u1eaft \u1edf m\u1ea1ch m\u00e1u ph\u1ed5i. \u0110\u00e2y l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nghi\u00eam tr\u1ecdng v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ea9n [&hellip;]<\/p>\n","protected":false},"author":4,"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 - 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