{"id":21306,"date":"2023-04-15T10:20:59","date_gmt":"2023-04-15T03:20:59","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21306"},"modified":"2023-04-17T15:13:12","modified_gmt":"2023-04-17T08:13:12","slug":"suy-tim-tre-em-phan-do-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/suy-tim-tre-em-phan-do-va-dieu-tri\/","title":{"rendered":"Suy tim tr\u1ebb em: Ph\u00e2n \u0111\u1ed9 v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Suy tim l\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 tim kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng \u0111\u1ea3m b\u1ea3o cung l\u01b0\u1ee3ng \u0111\u1ec3 \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c c\u00e1c nhu c\u1ea7u chuy\u1ec3n h\u00f3a c\u1ee7a c\u01a1 th\u1ec3. C\u00e1c h\u01b0\u1edbng d\u1eabn x\u1eed tr\u00ed suy tim \u1edf tr\u1ebb em hi\u1ec7n nay ch\u1ee7 y\u1ebfu b\u1eaft ngu\u1ed3n t\u1eeb nghi\u00ean c\u1ee9u ng\u01b0\u1eddi l\u1edbn. T\u1ea1i Vi\u1ec7t nam c\u00f3 r\u1ea5t \u00edt nghi\u00ean c\u1ee9u c\u00f3 h\u1ec7 th\u1ed1ng v\u00e0 ch\u01b0a c\u00f3 con s\u1ed1 th\u1ed1ng k\u00ea n\u00e0o v\u1ec1 suy tim \u1edf tr\u1ebb em. \u0110\u1ec3 g\u00f3p ph\u1ea7n cho ch\u1ea9n \u0111o\u00e1n s\u1edbm, ph\u00e2n lo\u1ea1i v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm suy tim \u1edf tr\u1ebb em<\/a> ngay khi v\u00e0o c\u1ea5p c\u1ee9u.<\/strong><\/p>\n

1. Ph\u00e2n \u0111\u1ed9 suy tim tr\u1ebb em<\/strong><\/h2>\n

Hi\u1ec7n nay c\u0169ng ch\u01b0a c\u00f3 m\u1ed9t c\u00e1ch ph\u00e2n lo\u1ea1i suy d\u00e0nh ri\u00eang cho tr\u1ebb em,<\/span> b\u1edfi v\u1eady ch\u00fang ta c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng b\u1ea3ng ph\u00e2n \u0111\u1ed9 suy tim c\u1ee7a hi\u1ec7p h\u1ed9i tim<\/span> m\u1ea1ch New York (New York Heart Association):<\/span><\/p>\n

    \n
  • \u00a0\u00d0\u1ed9 I: c\u00f3 b\u1ec7nh tim, nh\u01b0ng kh\u00f4ng b\u1ecb h\u1ea1n ch\u1ebf trong v\u1eadn \u0111\u1ed9ng. V\u1eadn \u0111\u1ed9ng th\u1ec3 l\u1ef1c th\u00f4ng th\u01b0\u1eddng<\/span> kh\u00f4ng g\u00e2y ra m\u1ec7t, h\u1ed3i h\u1ed9p, kh\u00f3 th\u1edf ho\u1eb7c \u0111au ng\u1ef1c.<\/span><\/li>\n
  • \u00d0\u1ed9 II: c\u00f3 b\u1ec7nh tim g\u00e2y ra gi\u1edbi h\u1ea1n nh\u1eb9 v\u1eadn \u0111\u1ed9ng. B\u1ec7nh nh\u00e2n kh\u1ecfe khi ngh\u1ec9 ng\u01a1i, v\u1eadn \u0111\u1ed9ng<\/span> th\u1ec3 l\u1ef1c th\u00f4ng th\u01b0\u1eddng g\u00e2y ra m\u1ec7t, h\u1ed3i h\u1ed9p, kh\u00f3 th\u1edf ho\u1eb7c \u0111au ng\u1ef1c.<\/span><\/li>\n
  • \u00d0\u1ed9 III: c\u00f3 b\u1ec7nh tim l\u00e0m gi\u1edbi h\u1ea1n nhi\u1ec1u v\u1eadn \u0111\u1ed9ng. B\u1ec7nh nh\u00e2n kh\u1ecfe khi ngh\u1ec9 ng\u01a1i, v\u1eadn \u0111\u1ed9ng<\/span> th\u1ec3 l\u1ef1c nh\u1eb9 c\u0169ng g\u00e2y ra m\u1ec7t, h\u1ed3i h\u1ed9p, kh\u00f3 th\u1edf ho\u1eb7c \u0111au ng\u1ef1c.<\/span><\/li>\n
  • \u00d0\u1ed9 IV: c\u00f3 b\u1ec7nh tim l\u00e0m kh\u00f4ng th\u1ec3 v\u1eadn \u0111\u1ed9ng m\u00e0 kh\u00f4ng kh\u00f3 ch\u1ecbu. Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng c\u1ee7a<\/span> suy tim x\u1ea3y ra c\u1ea3 khi ngh\u1ec9 ng\u01a1i, v\u1eadn \u0111\u1ed9ng d\u00f9 nh\u1eb9 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u0169ng t\u0103ng.<\/span><\/li>\n<\/ul>\n

    Theo Ross \u0111\u01b0\u1ee3c chia l\u00e0m 4 \u0111\u1ed9:<\/p>\n

      \n
    • \u0110\u1ed9 I: kh\u00f4ng tri\u1ec7u ch\u1ee9ng<\/li>\n
    • \u0110\u1ed9 II: th\u1edf nhanh nh\u1eb9 hay v\u00e3 m\u1ed3 h\u00f4i khi b\u00fa \u1edf tr\u1ebb nh\u0169 nhi; kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c tr\u1ebb l\u1edbn<\/li>\n
    • \u0110\u1ed9 III: th\u1edf nhanh nhi\u1ec1u hay v\u00e3 m\u1ed3 h\u00f4i khi b\u00fa; kh\u00f3 th\u1edf nhi\u1ec1u khi g\u1eafng s\u1ee9c tr\u1ebb l\u1edbn; th\u1eddi gian b\u00fa k\u00e9o d\u00e0i, ch\u1eadm t\u0103ng c\u00e2n<\/li>\n
    • \u0110\u1ed9 IV: th\u1edf nhanh co k\u00e9o, r\u00ean r\u1ec9, hay v\u00e3 m\u1ed3 h\u00f4i l\u00fac ngh\u1ec9<\/li>\n<\/ul>\n

      2. X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng<\/strong>
      \n<\/span><\/h2>\n

      – XQ tim ph\u1ed5i:<\/strong><\/p>\n

      \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span> B\u00f3ng tim to. Ngo\u1ea1i tr\u1eeb trong tr\u01b0\u1eddng h\u1ee3p t\u1eafc ngh\u1ebdn t\u0129nh m\u1ea1ch ph\u1ed5i, XQ cho th\u1ea5y ph\u00f9 ph\u1ed5i, xung huy\u1ebft ph\u1ed5i.<\/span><\/p>\n

      \"minh-hoa-suy-tim-tre-em\"<\/p>\n

      – \u00a0 \u00a0 \u00a0 ECG:<\/strong>
      \n<\/span> \u00a0 <\/span> C\u00f3 gi\u00e1 tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n r\u1ed1i lo\u1ea1n nh\u1ecbp, d\u1ef1 \u0111o\u00e1n th\u01b0\u01a1ng t\u1ed5n, kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n suy tim<\/span><\/p>\n

      –\u00a0 \u00a0Si\u00eau \u00e2m tim:<\/strong>
      \n<\/span> \u00a0 \u00a0 \u00a0 \u00a0 <\/span> X\u00e1c \u0111\u1ecbnh gi\u00e3n c\u00e1c bu\u1ed3ng tim v\u00e0 gi\u1ea3m ch\u1ee9c n\u0103ng co b\u00f3p c\u01a1 tim, hay gi\u1ea3m ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng, x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n, hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n

      –\u00a0 \u00a0Th\u00f4ng tim:<\/strong><\/p>\n

      \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span> Sinh thi\u1ebft c\u01a1 tim trong ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n (vi\u00eam, chuy\u1ec3n h\u00f3a..)\u00a0<\/span><\/p>\n

      – \u00a0 \u00a0 \u00a0 CT, MRI:<\/strong><\/p>\n

      \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span> X\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng, \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng. \u0110\u1eb7c bi\u1ec7t MRI c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1ea5t ph\u1ea3i<\/span><\/p>\n

      <\/b>3. C\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb suy tim \u1edf tr\u1ebb em<\/strong><\/h2>\n

      3.1. C\u00e1c thu\u1ed1c t\u0103ng co b\u00f3p c\u01a1 tim<\/strong><\/h3>\n

      –\u00a0 Digoxin<\/strong>
      \n<\/span> T\u0103ng s\u1ee9c co b\u00f3p c\u01a1 tim, l\u00e0m ch\u1eadm d\u1eabn truy\u1ec1n qua n\u00fat nh\u0129 th\u1ea5t, l\u00e0m ch\u1eadm nh\u1ecbp xoang. Thu\u1ed1c<\/span> h\u1ea5p thu theo \u0111\u01b0\u1eddng u\u1ed1ng kho\u1ea3ng 70-80%, ch\u1ee7 y\u1ebfu \u1edf d\u1ea1ng t\u1ef1 do trong m\u00e1u 80%, ph\u00e1t huy t\u00e1c<\/span> d\u1ee5ng sau 10 – 30 ph\u00fat qua \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch v\u00e0 1 \u0111\u1ebfn 2 gi\u1edd theo \u0111\u01b0\u1eddng u\u1ed1ng, th\u1eddi gian<\/span> b\u00e1n hu\u1ef7 t\u1eeb 36 -48 gi\u1edd, \u0111\u00e0o th\u1ea3i ch\u1ee7 y\u1ebfu qua th\u1eadn.<\/span>
      \n<\/span> – Thu\u1ed1c c\u00f3 ho\u1ea1t t\u00ednh gi\u1ed1ng giao c\u1ea3m (Dopamine, Dobutamine)<\/strong>
      \n<\/span> C\u00e1c thu\u1ed1c n\u00e0y th\u01b0\u1eddng ch\u1ec9 d\u00f9ng trong tr\u01b0\u1eddng h\u1ee3p suy tim n\u1eb7ng, c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb suy<\/span> tim c\u1ea5p h\u01a1n l\u00e0 suy tim m\u00e3n. Ho\u1ea1t t\u00ednh c\u00f3 \u0111\u01b0\u1ee3c l\u00e0 do k\u00edch th\u00edch th\u1ee5 c\u1ea3m beta c\u01a1 tim l\u00e0m t\u0103ng<\/span> co b\u00f3p c\u01a1 tim. T\u00e1c d\u1ee5ng c\u00f3 \u0111\u01b0\u1ee3c sau khi d\u00f9ng 2 – 4 ph\u00fat sau khi ti\u00eam t\u0129nh m\u1ea1ch, th\u1eddi gian b\u00e1n<\/span> hu\u1ef7 r\u1ea5t ng\u1eafn ch\u1ec9 sau 2 ph\u00fat n\u00ean c\u00e1c thu\u1ed1c n\u00e0y ch\u1ec9 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng qua \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch<\/span> nh\u1ecf gi\u1ecdt, th\u1ea3i tr\u1eeb ch\u1ee7 y\u1ebfu qua th\u1eadn.<\/span>
      \n<\/span> – \u1ee8c ch\u1ebf men phosphodiesterase(Amrinone, Milronone)<\/strong>
      \n<\/span> L\u00e0m t\u0103ng co b\u00f3p v\u00e0 gi\u00e3n m\u1ea1ch qua trung gian gia t\u0103ng n\u1ed3ng \u0111\u1ed9 AMP v\u00f2ng n\u1ed9i b\u00e0o. \u0111\u01b0\u1ee3c ch\u1ec9<\/span> \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p suy tim xung huy\u1ebft n\u1eb7ng. ho\u1ea1t t\u00ednh c\u00f3 \u0111\u01b0\u1ee3c do c\u00f3 \u0111\u01b0\u1ee3c ngay sau d\u00f9ng<\/span> v\u00e0 th\u1eddi gian b\u00e1n hu\u1ef7 r\u1ea5t ng\u1eafn ch\u1ec9 sau 5 ph\u00fat n\u00ean c\u00e1c thu\u1ed1c n\u00e0y th\u01b0\u1eddng s\u1eed d\u1ee5ng qua \u0111\u01b0\u1eddng truy\u1ec1n nh\u1ecf gi\u1ecdt t\u0129nh m\u1ea1ch. Th\u1ea3i tr\u1eeb ch\u1ee7 y\u1ebfu qua th\u1eadn.<\/span><\/p>\n

      3.2\u00a0 L\u1ee3i ti\u1ec3u<\/strong><\/h3>\n

      C\u00f3 ba nh\u00f3m l\u1ee3i ti\u1ec3u ch\u00ednh th\u01b0\u1eddng d\u00f9ng l\u00e0 nh\u00f3m thiazid, l\u1ee3i ti\u1ec3u v\u00f2ng, l\u1ee3i ti\u1ec3u gi\u1eef kali. L\u1ee3i<\/span> ti\u1ec3u gi\u1eef kali d\u00f9ng \u0111\u01a1n \u0111\u1ed9c c\u00f3 t\u00e1c d\u1ee5ng y\u1ebfu n\u00ean c\u1ea7n ph\u1ed1i h\u1ee3p v\u1edbi nh\u00f3m thiazid ho\u1eb7c l\u1ee3i ti\u1ec3u<\/span> v\u00f2ng<\/span><\/p>\n\n\n\n\n\n\n\n\n\n
      Nh\u00f3m<\/span><\/td>\nT\u00ean thu\u1ed1c<\/span><\/td>\nV\u1ecb tr\u00ed TD<\/span><\/td>\nH\u1ea5p thu <\/span>\u0111\u01b0\u1eddng <\/span>u\u1ed1ng<\/span><\/td>\nB\u1eaft \u0111\u1ea7u t\u00e1c <\/span>d\u1ee5ng<\/span><\/td>\nth\u1eddi gian t\u00e1c d\u1ee5ng<\/td>\n\u00d0\u00e0o<\/span>
      \n<\/span> th\u1ea3i<\/span><\/td>\n<\/tr>\n
      L\u1ee3i ti\u1ec3u<\/span>
      \n<\/span> v\u00f2ng<\/span><\/td>\n      		Furosemide<\/span><\/td>\nQuai Henle<\/span><\/td>\n60%<\/span><\/td>\n1 gi\u1edd<\/span><\/td>\n6-8 gi\u1edd<\/span><\/td>\nTh\u1eadn<\/span><\/td>\n<\/tr>\n
      Bumetanide<\/span><\/td>\nQuai Henle<\/span><\/td>\n95%<\/span><\/td>\n30 ph\u00fat<\/span><\/td>\n1-2 gi\u1edd<\/span><\/td>\nTh\u1eadn<\/span><\/td>\n<\/td>\n<\/tr>\n
      Thiazides<\/span><\/td>\nChlorothiazide<\/span><\/td>\n\u1ed0ng l\u01b0\u1ee3n<\/span>
      \n<\/span> xa<\/span><\/td>\n      		60%<\/span><\/td>\n2 gi\u1edd<\/span><\/td>\n6-12 gi\u1edd<\/span><\/td>\nth\u1eadn<\/span><\/td>\n<\/tr>\n
      Hydrochlorothiazid<\/span>e<\/span><\/td>\n\u1ed0ng l\u01b0\u1ee3n<\/span>
      \n<\/span> xa<\/span><\/td>\n      		50%<\/span><\/td>\n2 gi\u1edd<\/span><\/td>\n6-12 gi\u1edd<\/span><\/td>\nth\u1eadn<\/span><\/td>\n<\/td>\n<\/tr>\n
      L\u1ee3i ti\u1ec3u<\/span> gi\u1eef<\/span> Kali<\/span><\/td>\nSpironolactone<\/span><\/td>\n\u1ed0ng l\u01b0\u1ee3n<\/span>
      \n<\/span> xa \u1ed1ng g\u00f3p<\/span><\/td>\n      		95%<\/span><\/td>\n12- 24gi\u1edd<\/span><\/td>\n1-2 ng\u00e0y<\/span><\/td>\nTh\u1eadn<\/span><\/td>\n<\/tr>\n
      Triamt\u00e9r\u00e8ne<\/span><\/td>\n\u1ed0ng l\u01b0\u1ee3n<\/span>
      \n<\/span> xa \u1ed1ng g\u00f3p<\/span><\/td>\n      		95%<\/span><\/td>\n2-4 gi\u1edd<\/span><\/td>\n7-9 gi\u1edd<\/span><\/td>\nTh\u1eadn<\/span><\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

       <\/p>\n

      3.3 C\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch<\/strong><\/h3>\n

      – \u1ee8c ch\u1ebf men chuy\u1ec3n (captopril, Enalapril)<\/span>
      \n<\/span> T\u00e1c d\u1ee5ng tr\u00ean h\u1ec7 th\u1ed1ng Renin-angiotensin, ng\u0103n ch\u1eb7n chuy\u1ec3n angiotensin I th\u00e0nh angiotensin <\/span>\u00a0<\/span>II qua \u1ee9c ch\u1ebf men chuy\u1ec3n (Angiotensin II l\u00e0 m\u1ed9t ch\u1ea5t c\u00f3 t\u00e1c d\u1ee5ng g\u00e2y co m\u1ea1ch l\u00e0m t\u0103ng s\u1ee9c c\u1ea3n c\u1ee7a m\u1ea1ch m\u00e1u v\u00e0 t\u0103ng huy\u1ebft \u00e1p, \u0111\u1ed3ng th\u1eddi n\u00f3 c\u0169ng k\u00edch th\u00edch t\u0103ng ti\u1ebft andosterone g\u00e2y <\/span>\u00a0<\/span>gi\u1eef mu\u1ed1i v\u00e0 n\u01b0\u1edbc v\u00e0 k\u00edch th\u00edch h\u1ec7 th\u1ed1ng th\u1ea7n kinh giao c\u1ea3m. T\u1ea1i t\u1ebf b\u00e0o c\u01a1 tim angiotensin II <\/span>\u00a0<\/span>g\u00e2y t\u0103ng sinh v\u00e0 ph\u00ec \u0111\u1ea1i c\u01a1 tim). Thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n c\u1ea3 ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch v\u00e0 ti\u1ec3u t\u0129nh m\u1ea1ch, <\/span>\u00a0<\/span>\u0111\u1ed3ng th\u1eddi c\u0169ng \u1ee9c ch\u1ebf ti\u1ebft aldost\u00e9rone l\u00e0m gi\u1ea3m gi\u1eef mu\u1ed1i v\u00e0 n\u01b0\u1edbc. Thu\u1ed1c h\u1ea5p t\u1ed1t qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, th\u1ea3i tr\u1eeb ch\u1ee7 y\u1ebfu qua th\u1eadn.<\/span>
      \n<\/span> – Nh\u00f3m nitrat (Isosorbide dinitrate: Risordan, Isosorbide mononitrate: Imdur)<\/span>
      \n<\/span> T\u00e1c d\u1ee5ng g\u00e2y gi\u00e3n m\u1ea1ch t\u0129nh m\u1ea1ch \u0111\u01a1n thu\u1ea7n m\u00e0 kh\u00f4ng g\u00e2y gi\u00e3n \u0111\u1ed9ng m\u1ea1ch, l\u00e0m gi\u1ea3m th\u1ec3 <\/span>\u00a0<\/span>t\u00edch v\u00e0 \u00e1p l\u1ef1c t\u00e2m tr\u01b0\u01a1ng c\u1ee7a th\u1ea5t tr\u00e1i. H\u1ea5p th\u1ee5 ho\u00e0n to\u00e0n qua \u0111\u01b0\u1eddng u\u1ed1ng, t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i <\/span>\u00a0<\/span>t\u1eeb 2-6 gi\u1edd, th\u1ea3i tr\u1eeb ho\u00e0n to\u00e0n qua \u0111\u01b0\u1eddng th\u1eadn.<\/span>
      \n<\/span> – Hydralazine<\/span>
      \n<\/span> C\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n \u0111\u1ed9ng m\u1ea1ch \u0111\u01a1n thu\u1ea7n l\u00e0m gi\u1ea3m h\u1eadu g\u00e1nh t\u1ed1t nh\u01b0ng kh\u00f4ng l\u00e0m gi\u1ea3m ti\u1ec1n <\/span>\u00a0<\/span>g\u00e1nh. Thu\u1ed1c h\u1ea5p thu t\u1ed1t qua \u0111\u01b0\u1eddng ti\u00eau ho\u00e1, b\u1eaft \u0111\u1ea7u c\u00f3 t\u00e1c d\u1ee5ng sau 1-2 gi\u1edd, t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i <\/span>\u00a0<\/span>2-3 gi\u1edd.<\/span>
      \n<\/span> –\u00a0 Nitroprusside<\/span>
      \n<\/span> C\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n \u0111\u1ed9ng m\u1ea1ch nhi\u1ec1u h\u01a1n t\u0129nh m\u1ea1ch, thu\u1ed1c n\u00e0y ch\u1ec9 d\u00f9ng khi c\u1ea5p c\u1ee9u .<\/span><\/p>\n


      \n<\/span> 4. \u0110i\u1ec1u tr\u1ecb suy tim tr\u1ebb em<\/strong><\/h2>\n

      4.1. Nguy\u00ean t\u1eafc chung<\/strong><\/h3>\n

      V\u00ec suy tim l\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 tim m\u1ea5t kh\u1ea3 n\u0103ng \u0111\u1ea3m b\u1ea3o cung l\u01b0\u1ee3ng \u0111\u1ec3 \u0111\u00e1p \u1ee9ng nhu c\u1ea7u chuy\u1ec3n <\/span>\u00a0<\/span>h\u00f3a c\u1ee7a c\u01a1 th\u1ec3, n\u00ean \u0111i\u1ec1u tr\u1ecb ph\u1ea3i:<\/span>
      \n<\/span> – H\u1ea1n ch\u1ebf m\u1ecdi bi\u1ebfn \u0111\u1ed5i v\u1ec1 nhu c\u1ea7u chuy\u1ec3n h\u00f3a.<\/span>
      \n<\/span> – T\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho c\u01a1 th\u1ec3 d\u1ec5 th\u00edch nghi.<\/span>
      \n<\/span> – \u00d0\u1eb7c bi\u1ec7t l\u00e0 t\u00ecm m\u1ecdi bi\u1ec7n ph\u00e1p \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o cung l\u01b0\u1ee3ng tim.<\/span><\/p>\n


      \n<\/span> 4.2. C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb<\/strong><\/h3>\n

      * C\u00e1c bi\u1ec7n ph\u00e1p chung<\/span>
      \n<\/span> – Cung c\u1ea5p \u0111\u1ee7 oxy: th\u1edf oxy qua sonde, qua m\u1eb7t n\u1ea1, th\u1edf m\u00e1y n\u1ebfu c\u1ea7n.<\/span>
      \n<\/span> – H\u1ea1n ch\u1ebf t\u0103ng nhu c\u1ea7u oxy c\u01a1 th\u1ec3<\/span>
      \n<\/span> + Ngh\u1ec9 ng\u01a1i, h\u1ea1n ch\u1ebf m\u1ecdi ho\u1ea1t \u0111\u1ed9ng g\u1eafng s\u1ee9c.<\/span>
      \n<\/span> + Gi\u1ea3m s\u1ed1t v\u00e0 c\u00e1c nhi\u1ec5m tr\u00f9ng kh\u00e1c.<\/span>
      \n<\/span> + Tr\u00e1nh sang ch\u1ea5n \u0111\u1ed9t ng\u1ed9t g\u00e2y \u2191 Catecholamin: l\u1ea1nh, \u0111au, lo s\u1ee3.<\/span>
      \n<\/span> – \u00d0\u1ea3m b\u1ea3o \u0111\u1ee7 n\u0103ng l\u01b0\u1ee3ng (100 x 120 Kcal\/ kg\/ ng\u00e0y).<\/span>
      \n<\/span> – \u00d0i\u1ec1u ch\u1ec9nh c\u00e1c r\u1ed1i lo\u1ea1n b\u1ea5t l\u1ee3i cho c\u01a1 th\u1ec3:<\/span>
      \n<\/span> + \u00d0\u1ea3m b\u1ea3o Hb > 10g%<\/span>
      \n<\/span> + Hematocrit t\u1eeb 30 – 35%.<\/span>
      \n<\/span> + Hematocrit t\u1eeb 45 – 50% \u1edf tr\u1ebb c\u00f3 lu\u1ed3ng th\u00f4ng ph\u1ea3i-tr\u00e1i.<\/span>
      \n<\/span> + \u00d0i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a toan ki\u1ec1m v\u00e0 \u0111i\u1ec7n gi\u1ea3i.<\/span>
      \n<\/span> – \u00d0i\u1ec1u tr\u1ecb l\u00fac \u0111\u1ea7u v\u00e0 giai \u0111o\u1ea1n n\u1eb7ng n\u00ean \u0111\u01b0a thu\u1ed1c v\u00e0 n\u0103ng l\u01b0\u1ee3ng b\u1eb1ng \u0111\u01b0\u1eddng TM, tr\u00e1nh t\u1eafc <\/span>\u00a0<\/span>m\u1ea1ch do kh\u00ed \u1edf b\u1ec7nh tim c\u00f3 shunt ph\u1ea3i – tr\u00e1i.<\/span>
      \n<\/span> * \u00d0i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng:<\/span>
      \n<\/span> – Ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 c\u00e1c c\u00e1c b\u1ec7nh tim m\u1ea1ch.<\/span>
      \n<\/span> – Lo\u1ea1i tr\u1eeb c\u00e1c y\u1ebfu t\u1ed1 l\u00e0m n\u1eb7ng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim m\u1ea1ch nh\u01b0 nhi\u1ec5m tr\u00f9ng, lo\u1ea1n nh\u1ecbp, <\/span>\u00a0<\/span>thi\u1ebfu m\u00e1u, c\u00e1c thu\u1ed1c, \u0111\u1ed9c ch\u1ea5t (chi\u1ebfu tia x\u1ea1, thu\u1ed1c anthracyclines), kh\u00f4ng theo \u0111\u00fang y\u00eau c\u1ea7u <\/span>\u00a0<\/span>v\u1ec1 h\u1ea1n ch\u1ebf dinh d\u01b0\u1ee1ng.<\/span>
      \n<\/span> – H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng qu\u00e1 s\u1ee9c n\u00ean t\u0103ng c\u01b0\u1eddng ngh\u1ec9 ng\u01a1i c\u1ea3 v\u1ec1 th\u1ec3 x\u00e1c l\u1eabn tinh th\u1ea7n.<\/span>
      \n<\/span> – Ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng n\u00ean \u0111\u1ee7 n\u0103ng l\u01b0\u1ee3ng nh\u01b0ng h\u1ea1n ch\u1ebf mu\u1ed1i Natri.<\/span><\/p>\n

      T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/b><\/p>\n

        \n
      1. Gi\u00e1o tr\u00ecnh Nhi khoa t\u1eadp II. B\u1ed9 M\u00f4n Nhi. \u0110\u1ea1i h\u1ecdc Y d\u01b0\u1ee3c TPHCM<\/span><\/li>\n
      2. Gi\u00e1o tr\u00ecnh Nhi Khoa \u0110\u1ea1i h\u1ecdc Y d\u01b0\u1ee3c Hu\u1ebf<\/span><\/li>\n
      3. Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb N\u1ed9i khoa , B\u1ec7nh vi\u1ec7n Nhi \u0111\u1ed3ng 1.<\/span><\/li>\n<\/ol>\n

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

        Suy tim l\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 tim kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng \u0111\u1ea3m b\u1ea3o cung l\u01b0\u1ee3ng \u0111\u1ec3 \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c c\u00e1c nhu c\u1ea7u chuy\u1ec3n h\u00f3a c\u1ee7a c\u01a1 th\u1ec3. C\u00e1c h\u01b0\u1edbng d\u1eabn x\u1eed tr\u00ed suy tim \u1edf tr\u1ebb em hi\u1ec7n nay ch\u1ee7 y\u1ebfu b\u1eaft ngu\u1ed3n t\u1eeb nghi\u00ean c\u1ee9u ng\u01b0\u1eddi l\u1edbn. T\u1ea1i Vi\u1ec7t nam c\u00f3 r\u1ea5t \u00edt nghi\u00ean […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nSuy tim tr\u1ebb em: Ph\u00e2n \u0111\u1ed9 v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Suy tim l\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 tim kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng \u0111\u1ea3m b\u1ea3o cung l\u01b0\u1ee3ng \u0111\u1ec3 \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c c\u00e1c nhu c\u1ea7u chuy\u1ec3n h\u00f3a c\u1ee7a c\u01a1 th\u1ec3.\" \/>\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=\"Suy tim tr\u1ebb em: Ph\u00e2n \u0111\u1ed9 v\u00e0 \u0111i\u1ec1u tr\u1ecb - 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