{"id":2154,"date":"2023-04-10T10:38:38","date_gmt":"2023-04-10T03:38:38","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2154"},"modified":"2023-04-18T15:50:48","modified_gmt":"2023-04-18T08:50:48","slug":"hoi-chung-than-hu","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/hoi-chung-than-hu\/","title":{"rendered":"C\u01a1 ch\u1ebf ph\u00f9 trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0"},"content":{"rendered":"

Ph\u00f9 l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng ph\u1ed5 bi\u1ebfn trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0. Ph\u00f9 th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n tr\u00ean c\u01a1 th\u1ec3, ch\u1ee7 y\u1ebfu \u1edf v\u00f9ng ch\u00e2n, m\u1eaft, tay v\u00e0 b\u1ee5ng. Tuy nhi\u00ean, c\u01a1 ch\u1ebf c\u1ee7a ph\u00f9 trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 ch\u01b0a th\u1eadt s\u1ef1 r\u00f5 r\u00e0ng. Trong b\u00e0i vi\u1ebft n\u00e0y s\u1ebd tr\u00ecnh b\u00e0y m\u1ed9t s\u1ed1 tranh lu\u1eadn trong c\u01a1 ch\u1ebf ph\u00f9 c\u1ee7a h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0.<\/strong><\/p>\n

1. C\u00e1c tranh lu\u1eadn trong c\u01a1 ch\u1ebf ph\u00f9<\/strong><\/h2>\n

Ph\u00f9 trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 l\u00e0 d\u1ecbch ti\u1ebft c\u00f3 n\u1ed3ng \u0111\u1ed9 protein th\u1ea5p (<3 g\/dL) v\u00e0 c\u00f3 \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 t\u1ebf b\u00e0o. Tr\u00e1i ng\u01b0\u1ee3c v\u1edbi c\u00e1c d\u1ea1ng ph\u00f9 n\u1ec1 kh\u00e1c, ph\u00f9 c\u00f3 d\u1ea1ng r\u1ed7, c\u00f3 xu h\u01b0\u1edbng lan r\u1ed9ng v\u00e0 n\u1ed5i b\u1eadt h\u01a1n \u1edf c\u00e1c v\u00f9ng c\u01a1 th\u1ec3 ph\u1ee5 thu\u1ed9c n\u01a1i \u00e1p su\u1ea5t th\u1ee7y l\u1ef1c mao m\u1ea1ch cao (m\u1eaft c\u00e1 ch\u00e2n v\u00e0 b\u00e0n ch\u00e2n) ho\u1eb7c \u1edf c\u00e1c m\u00f4 c\u00f3 s\u1ee9c c\u1ea3n th\u1ea5p ho\u1eb7c th\u1ee7y l\u1ef1c k\u1ebd th\u1ea5p (m\u00ed m\u1eaft, \u0111\u01b0\u1eddng ti\u00eau h\u00f3a\/b\u1ee5ng v\u00e0 b\u00ecu). [3]<\/p>\n

Ph\u00f9 trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 tr\u01b0\u1edbc \u0111\u00e2y \u0111\u01b0\u1ee3c cho l\u00e0 do \u00e1p l\u1ef1c keo huy\u1ebft t\u01b0\u01a1ng gi\u1ea3m do gi\u1ea3m albumin m\u00e1u. Khi \u00e1p su\u1ea5t keo th\u1ea5p, d\u1ecbch t\u1eeb l\u00f2ng m\u1ea1ch s\u1ebd ra kho\u1ea3ng k\u1ebd l\u00e0m gi\u1ea3m th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng d\u1eabn \u0111\u1ebfn qu\u00e1 tr\u00ecnh k\u00edch ho\u1ea1t qu\u00e1 tr\u00ecnh t\u0103ng gi\u1eef mu\u1ed1i n\u01b0\u1edbc b\u00f9 \u0111\u1eafp t\u00ecnh tr\u1ea1ng gi\u1ea3m huy\u1ebft t\u01b0\u01a1ng th\u00f4ng qua k\u00edch ho\u1ea1t tr\u1ee5c Renin \u2013 Angiotensin \u2013 Adosteron, Vasopressin v\u00e0 h\u1ec7 th\u1ed1ng th\u1ea7n kinh giao c\u1ea3m (Thuy\u1ebft \u201cUnderfill\u201d). [2]<\/p>\n

Tuy nhi\u00ean, c\u00e1c d\u1eef li\u1ec7u th\u1ef1c nghi\u1ec7m cho th\u1ea5y th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng t\u0103ng ho\u1eb7c b\u00ecnh th\u01b0\u1eddng. Gi\u1ea3m albumin kh\u00f4ng g\u00e2y ph\u00f9 cho \u0111\u1ebfn khi n\u1ed3ng \u0111\u1ed9 Albumin huy\u1ebft thanh nh\u1ecf h\u01a1n 2 g\/dL (20 g\/L). Ngo\u00e0i ra, s\u1ef1 d\u1ecbch chuy\u1ec3n d\u1ecbch do ch\u00eanh l\u1ec7ch \u00e1p l\u1ef1c keo kh\u00f4ng cao nh\u01b0 c\u01a1 ch\u1ebf tr\u01b0\u1edbc \u0111\u00e2y \u0111\u01b0a ra do h\u1ec7 b\u1ea1ch huy\u1ebft t\u0103ng d\u1eabn truy\u1ec1n d\u1ecbch v\u00e0 Protein trong m\u00f4 k\u1ebd l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c keo m\u00f4 k\u1ebd. [2]<\/p>\n

Thay v\u00e0o \u0111\u00f3, t\u00ecnh tr\u1ea1ng gi\u1eef n\u01b0\u1edbc c\u00f3 th\u1ec3 x\u1ea3y ra do s\u1ef1 t\u0103ng h\u1ea5p thu Natri t\u1ea1i \u1ed1ng l\u01b0\u1ee3n xa (do \u1ed1ng th\u1eadn \u0111\u1ec1 kh\u00e1ng v\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a peptid l\u1ee3i ti\u1ec3u th\u1ea3i Natri type A (Thuy\u1ebft \u201cOverfill\u201d) . C\u00f3 th\u1ec3 c\u1ea3 2 c\u01a1 ch\u1ebf g\u00f3p ph\u1ea7n g\u00e2y ph\u00f9 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00e1c nhau. [2]<\/p>\n

\"\"<\/p>\n

1.1. T\u0103ng gi\u1eef Natri nguy\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t<\/strong><\/p>\n

Trong c\u00e1c c\u01a1 ch\u1ebf \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t cho ph\u00f9 th\u1eadn h\u01b0 tr\u01b0\u1edbc \u0111\u00e2y m\u00f4 t\u1ea3 s\u1ef1 gi\u1eef Na+ th\u00f4ng qua c\u00e1c c\u01a1 ch\u1ebf th\u1ee9 ph\u00e1t (thuy\u1ebft \u201cunderfill\u201d) v\u00e0 nguy\u00ean ph\u00e1t (thuy\u1ebft \u201coverfill\u201d), th\u00ec hi\u1ec7n nay c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a c\u00e1c nghi\u00ean c\u1ee9u ch\u1ec9 ra r\u1eb1ng vi\u1ec7c gi\u1eef Na+ nguy\u00ean ph\u00e1t c\u00f3 th\u1ec3 x\u1ea3y ra theo m\u1ed9t c\u01a1 ch\u1ebf chung cho t\u1ea5t c\u1ea3 nh\u1eefng ng\u01b0\u1eddi v\u1eabn ti\u1ec3u \u0111\u01b0\u1ee3c b\u00ecnh th\u01b0\u1eddng trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o m\u00f4 h\u1ecdc ho\u1eb7c t\u00ecnh tr\u1ea1ng th\u1ec3 t\u00edch m\u00e1u. [3]<\/p>\n

M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho th\u1ea5y m\u1ea5t plasmin v\u00e0 c\u00e1c Protease Serine kh\u00e1c trong n\u01b0\u1edbc ti\u1ec3u trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u ch\u1ec9nh t\u0103ng c\u1ee7a k\u00eanh natri bi\u1ec3u m\u00f4 (ENaC) g\u00e2y ra t\u00ecnh tr\u1ea1ng gi\u1eef Na+ v\u00e0 n\u01b0\u1edbc.[3]<\/p>\n

1.2. T\u00ecnh tr\u1ea1ng gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n<\/strong><\/p>\n

D\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng v\u00e0 c\u01a1 s\u1edf l\u00fd thuy\u1ebft, quan \u0111i\u1ec3m ph\u1ed5 bi\u1ebfn t\u1eeb l\u00e2u l\u00e0 tr\u1ebb em v\u00e0 ng\u01b0\u1eddi l\u1edbn b\u1ecb ph\u00f9 trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 c\u00f3 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch. [3]<\/p>\n

M\u1eb7c d\u00f9 m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u1ee7ng h\u1ed9 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u00ecnh tr\u1ea1ng gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n \u1edf ng\u01b0\u1eddi l\u1edbn m\u1eafc th\u1ec3 sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u so v\u1edbi c\u00e1c d\u1ea1ng m\u00f4 h\u1ecdc kh\u00e1c, v\u00e0 \u1edf m\u1ed9t s\u1ed1 tr\u1ebb em c\u00f3 th\u1ec3 sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u, c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c ch\u1ec9 ra r\u1eb1ng h\u1ea7u h\u1ebft ng\u01b0\u1eddi l\u1edbn v\u00e0 m\u1ed9t s\u1ed1 tr\u1ebb em m\u1eafc h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 do b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n n\u00e0o c\u00f3 th\u1ec3 t\u00edch m\u00e1u b\u00ecnh th\u01b0\u1eddng ho\u1eb7c t\u0103ng, v\u00e0 kh\u00f4ng bi\u1ec3u hi\u1ec7n h\u1ea1 huy\u1ebft \u00e1p th\u1ebf \u0111\u1ee9ng ho\u1eb7c c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u gi\u1ea3m th\u1ec3 t\u00edch kh\u00e1c. [3]<\/p>\n

\u0110\u1ec3 hi\u1ec3u r\u00f5 h\u01a1n v\u1ec1 sinh l\u00fd b\u1ec7nh ph\u00f9 n\u1ec1 \u1edf tr\u1ebb em m\u1eafc h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, Vande Walle et al \u0111\u00e3 nghi\u00ean c\u1ee9u tr\u1ebb em t\u00e1i ph\u00e1t h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 s\u1edbm v\u00e0 th\u1ea5y r\u1eb1ng ch\u00fang \u0111\u01b0\u1ee3c nh\u00f3m th\u00e0nh ba bi\u1ec3u hi\u1ec7n [3]:<\/p>\n

    \n
  • C\u00f3 protein ni\u1ec7u xu\u1ea5t hi\u1ec7n nh\u01b0ng kh\u00f4ng ph\u00f9, c\u00f3 t\u00ecnh tr\u1ea1ng gi\u1eef Na+ v\u00e0 t\u0103ng nh\u1eb9 aldosterone tu\u1ea7n ho\u00e0n, t\u0103ng l\u01b0u l\u01b0\u1ee3ng huy\u1ebft t\u01b0\u01a1ng th\u1eadn v\u00e0 n\u1ed3ng \u0111\u1ed9 norepinephrine v\u1eabn b\u00ecnh th\u01b0\u1eddng.<\/li>\n
  • C\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n, xu\u1ea5t hi\u1ec7n ph\u00f9, c\u00f3 t\u00ecnh tr\u1ea1ng \u00a0gi\u1eef Na+, t\u0103ng n\u1ed3ng \u0111\u1ed9 renin, aldosterone v\u00e0 Norepinephrine huy\u1ebft t\u01b0\u01a1ng, c\u00f3 t\u00ecnh tr\u1ea1ng peptid natri l\u1ee3i ni\u1ec7u t\u00e2m nh\u0129 th\u1ea5p v\u00e0 gi\u1ea3m GFR.<\/li>\n
  • Xu\u1ea5t hi\u1ec7n ph\u00f9 nh\u01b0ng kh\u00f4ng gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n, kh\u00f4ng c\u00f3 t\u00ecnh tr\u1ea1ng gi\u1eef Na+, c\u00e1c hormone huy\u1ebft t\u01b0\u01a1ng b\u00ecnh th\u01b0\u1eddng v\u00e0 GFR b\u00ecnh th\u01b0\u1eddng.<\/li>\n<\/ul>\n

    Nh\u1eefng d\u1eef li\u1ec7u n\u00e0y r\u1ea5t quan tr\u1ecdng v\u00ec ch\u00fang ch\u1ec9 ra r\u1eb1ng c\u00f3 s\u1ef1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng v\u00e0 sinh h\u00f3a \u1edf tr\u1ebb em m\u1eafc h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0. Vi\u1ec7c ph\u00e2n bi\u1ec7t c\u00e1c c\u01a1 ch\u1ebf c\u01a1 b\u1ea3n n\u00e0y gi\u00fap d\u1ef1 \u0111o\u00e1n l\u00e2m s\u00e0ng v\u1ec1 t\u00ednh an to\u00e0n v\u00e0 l\u1ee3i \u00edch c\u1ee7a li\u1ec7u ph\u00e1p l\u1ee3i ti\u1ec3u: thu\u1ed1c l\u1ee3i ti\u1ec3u \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t \u1edf tr\u1ebb em b\u1ecb \u1ee9 Na+ \u1edf th\u1eadn nguy\u00ean ph\u00e1t nh\u01b0ng n\u1ebfu c\u01a1 ch\u1ebf ph\u00f9 theo thuy\u1ebft \u201cUnderfill\u201d l\u00e0 ch\u1ee7 y\u1ebfu th\u00ec vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam t\u00ecnh tr\u1ea1ng gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n v\u00e0 gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4.[3]<\/p>\n

    1.3. Vai tr\u00f2 c\u1ee7a Albumin huy\u1ebft t\u01b0\u01a1ng<\/strong><\/p>\n

    Ngo\u1ea1i tr\u1eeb tr\u01b0\u1eddng h\u1ee3p gi\u1ea3m albumin m\u00e1u r\u00f5 r\u1ec7t (<2.0 g\/dL) v\u00e0 \u00e1p l\u1ef1c keo huy\u1ebft t\u01b0\u01a1ng d\u01b0\u1edbi 8\u201310 mmHg, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng v\u00e0 th\u1ef1c nghi\u1ec7m \u0111\u1eb7t c\u00e2u h\u1ecfi v\u1ec1 vai tr\u00f2 th\u1eadt s\u1ef1 c\u1ee7a gi\u1ea3m albumin m\u00e1u trong c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a ph\u00f9 th\u1eadn h\u01b0. V\u00ed d\u1ee5, c\u00e1c nghi\u00ean c\u1ee9u tr\u00ean chu\u1ed9t analbumine huy\u1ebft cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 v\u1ec1 \u0111\u1ed9 ch\u00eanh l\u1ec7ch \u00e1p su\u1ea5t keo xuy\u00ean mao m\u1ea1ch ho\u1eb7c xu h\u01b0\u1edbng ph\u00f9 n\u1ec1 so v\u1edbi nh\u00f3m ch\u1ee9ng. Ngo\u00e0i ra, 81% nh\u1eefng ng\u01b0\u1eddi b\u1ecb thi\u1ebfu albumin m\u00e1u b\u1ea9m sinh (r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u1ee7a gen albumin d\u1eabn \u0111\u1ebfn gi\u1ea3m albumin m\u00e1u r\u00f5 r\u1ec7t) c\u00f3 \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 ph\u00f9.[3]<\/p>\n

    Vi\u1ec7c s\u1eed d\u1ee5ng albumin c\u00f4 \u0111\u1eb7c kh\u00f4ng g\u00e2y thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 d\u1ecbch ph\u00f9 \u1edf nhi\u1ec1u \u0111\u1ed1i t\u01b0\u1ee3ng h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, m\u1eb7c d\u00f9 b\u00e0i ti\u1ebft Na+ c\u00f3 th\u1ec3 t\u0103ng t\u1ea1m th\u1eddi \u1edf m\u1ed9t s\u1ed1 ng\u01b0\u1eddi. Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n m\u1eafc th\u1ec3 sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticosteroid th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng l\u1ee3i ti\u1ec3u tr\u01b0\u1edbc khi n\u1ed3ng \u0111\u1ed9 albumin huy\u1ebft thanh b\u1eaft \u0111\u1ea7u t\u0103ng; ph\u00e1t hi\u1ec7n n\u00e0y cho th\u1ea5y r\u1eb1ng vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh t\u00ecnh tr\u1ea1ng gi\u1ea3m albumin m\u00e1u c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n thi\u1ebft trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u ch\u1ec9nh Natri ni\u1ec7u do steroid g\u00e2y ra.[3]<\/p>\n

    Tuy nhi\u00ean, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u ch\u1ee9ng minh vai tr\u00f2 c\u1ee7a albumin trong c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a ph\u00f9 c\u00f3 th\u1ec3 kh\u00f4ng gi\u1ea3i th\u00edch r\u00f5 t\u00ecnh tr\u1ea1ng ph\u00f9 \u1edf ng\u01b0\u1eddi m\u00e0 tr\u00ean th\u1ef1c t\u1ebfc\u00e1c y\u1ebfu t\u1ed1 th\u1ea5m th\u00e0nh m\u1ea1ch v\u00e0 c\u00e1c cytokine c\u00f3 th\u1ec3 \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c ng\u0103n ch\u1eb7n s\u1ef1 thay \u0111\u1ed5i c\u1ee7a ch\u00eanh l\u1ec7ch \u00e1p su\u1ea5t keo th\u1ec3 hi\u1ec7n r\u00f5 khi thi\u1ebfu albumin m\u00e1u b\u1ea9m sinh ho\u1eb7c trong qu\u00e1 tr\u00ecnh l\u1ecdc huy\u1ebft t\u01b0\u01a1ng th\u1ef1c nghi\u1ec7m.[3]<\/p>\n

    1.4. C\u00e1c y\u1ebfu t\u1ed1 b\u1ea3o v\u1ec7 ch\u1ed1ng l\u1ea1i ph\u00f9<\/strong><\/p>\n

    Th\u00f4ng th\u01b0\u1eddng c\u00f3 m\u1ed9t ch\u00eanh l\u1ec7ch \u00e1p su\u1ea5t nh\u1ecf \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn qu\u00e1 tr\u00ecnh l\u1ecdc qua c\u00e1c mao m\u1ea1ch, n\u00ean c\u00f3 th\u1ec3 cho r\u1eb1ng ch\u1ec9 m\u1ed9t thay \u0111\u1ed5i nh\u1ecf trong c\u00e1c l\u1ef1c n\u00e0y s\u1ebd d\u1eabn \u0111\u1ebfn ph\u00f9. Tuy nhi\u00ean, c\u00e1c nghi\u00ean c\u1ee9u th\u1ef1c nghi\u1ec7m v\u00e0 l\u00e2m s\u00e0ng ch\u1ec9 ra r\u1eb1ng ph\u1ea3i c\u00f3 s\u1ef1 gia t\u0103ng \u00edt nh\u1ea5t 15 mmHg trong ch\u00eanh l\u1ec7ch \u00e1p su\u1ea5t tr\u01b0\u1edbc khi c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n ph\u00f9.[3]<\/p>\n

    Khi \u00e1p su\u1ea5t n\u00e0y gi\u1ea3m \u00edt h\u01a1n 15 mmHg, ph\u00f9 kh\u00f3 c\u00f3 th\u1ec3 x\u1ea3y ra do ba y\u1ebfu t\u1ed1 b\u00f9 tr\u1eeb.[3]<\/p>\n

      \n
    • \u0110\u1ea7u ti\u00ean, b\u1eb1ng ch\u1ee9ng th\u1ef1c nghi\u1ec7m ch\u1ec9 ra r\u1eb1ng c\u00f3 s\u1ef1 gia t\u0103ng l\u01b0u l\u01b0\u1ee3ng b\u1ea1ch huy\u1ebft, theo d\u00f2ng ch\u1ea3y l\u1edbn, c\u0169ng s\u1ebd lo\u1ea1i b\u1ecf albumin v\u00e0 gi\u00fap lo\u1ea1i b\u1ecf m\u1ed9t s\u1ed1 d\u1ecbch l\u1ecdc d\u01b0 th\u1eeba.<\/li>\n
    • Th\u1ee9 hai, d\u1ecbch x\u00e2m nh\u1eadp v\u00e0o kho\u1ea3ng k\u1ebd cu\u1ed1i c\u00f9ng s\u1ebd l\u00e0m t\u0103ng \u00e1p su\u1ea5t th\u1ee7y t\u0129nh kho\u1ea3ng k\u1ebd, do \u0111\u00f3 ch\u1ed1ng l\u1ea1i qu\u00e1 tr\u00ecnh l\u1ecdc v\u00e0 t\u00edch t\u1ee5 d\u1ecbch \u1edf m\u00f4 k\u1ebd.<\/li>\n
    • Th\u1ee9 ba, s\u1ef1 t\u00edch t\u1ee5 d\u1ecbch trong m\u00f4 k\u1ebd \u0111\u1ed3ng th\u1eddi l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c keo \u1edf m\u00f4 k\u1ebd m\u00e0 \u1edf ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng l\u00e0 12\u201315 mmHg.<\/li>\n<\/ul>\n

      Do \u0111\u00f3, s\u1ef1 gi\u1ea3m d\u1ea7n \u00e1p su\u1ea5t keo huy\u1ebft t\u01b0\u01a1ng trong NS c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 gi\u1ea3m song song c\u1ee7a \u00e1p su\u1ea5t keo m\u00f4 k\u1ebd v\u00e0 t\u0103ng \u00e1p su\u1ea5t th\u1ee7y t\u0129nh m\u00f4 k\u1ebd, gi\u00fap gi\u1ea3m thi\u1ec3u s\u1ef1 thay \u0111\u1ed5i trong gradient \u00e1p su\u1ea5t xuy\u00ean mao m\u1ea1ch c\u00f3 l\u1ee3i cho s\u1ef1 di chuy\u1ec3n c\u1ee7a d\u1ecbch ra kh\u1ecfi m\u1ea1ch m\u00e1u \u00a0d\u1eabn \u0111\u1ebfn b\u1ea3o to\u00e0n t\u01b0\u01a1ng \u0111\u1ed1i th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng.[3]<\/p>\n

      K\u1ebft qu\u1ea3 c\u1ee7a nh\u1eefng ph\u1ea3n \u1ee9ng sinh l\u00fd b\u00f9 tr\u1eeb n\u00e0y l\u00e0 th\u01b0\u1eddng g\u00e2y\u00a0 ra r\u1ea5t \u00edt thay \u0111\u1ed5i v\u1ec1 ch\u00eanh l\u1ec7ch \u00e1p su\u1ea5t keo xuy\u00ean mao m\u1ea1ch \u1edf tr\u1ebb em m\u1eafc h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, v\u00e0 do \u0111\u00f3 \u00edt c\u00f3 xu h\u01b0\u1edbng gi\u1ea3m th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng, tr\u1eeb khi t\u00ecnh tr\u1ea1ng h\u1ea1 albumin m\u00e1u nghi\u00eam tr\u1ecdng. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1eady, mi\u1ec5n l\u00e0 tr\u1ebb b\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 kh\u00f4ng b\u1ecb b\u00e0i ni\u1ec7u qu\u00e1 m\u1ee9c, th\u1ec3 t\u00edch huy\u1ebft t\u01b0\u01a1ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c b\u1ea3o to\u00e0n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u \u0111\u1ec3 gi\u1ea3m ph\u00f9.[3]<\/p>\n

      2. \u0110\u1eb7c \u0111i\u1ec3m ph\u00f9 trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/strong><\/h2>\n

      L\u00e0 bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t v\u00e0 l\u00e0 bi\u1ec3u hi\u1ec7n khi\u1ebfn nhi\u1ec1u ng\u01b0\u1eddi \u0111\u1ebfn kh\u00e1m.[1]<\/p>\n

        \n
      • Ph\u00f9 to\u00e0n th\u00e2n.<\/li>\n
      • Ph\u00f9 th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u0111\u1ea7u ti\u00ean \u1edf m\u1eb7t, nhi\u1ec1u v\u00e0o bu\u1ed5i s\u00e1ng l\u00fac m\u1edbi ng\u1ee7 d\u1eady, sau \u0111\u00f3 lan ra to\u00e0n th\u00e2n, ph\u00f9 \u1edf ch\u00e2n, \u1edf m\u1eaft c\u00e1, v\u00f9ng h\u00f4ng l\u01b0ng khi n\u1eb1m l\u00e2u, ph\u00f9 b\u00ecu, ph\u00f9 \u00e2m h\u1ed9.<\/li>\n
      • Ph\u00f9 c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m m\u1ec1m, tr\u1eafng, \u1ea5n l\u00f5m, kh\u00f4ng \u0111au, \u0111\u1ed1i x\u1ee9ng hai b\u00ean.<\/li>\n
      • Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng h\u01a1n, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 t\u00ecnh tr\u1ea1ng tr\u00e0n d\u1ecbch \u0111a m\u00e0ng nh\u01b0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, tr\u00e0n d\u1ecbch m\u00e0ng tim, m\u00e0ng b\u1ee5ng. Ph\u00f9 c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t ho\u1eb7c t\u0103ng d\u1ea7n theo th\u1eddi gian.<\/li>\n<\/ul>\n

        H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd c\u1ee7a th\u1eadn, khi ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o th\u1eadn b\u1ecb suy gi\u1ea3m ho\u1eb7c m\u1ea5t \u0111i. B\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 th\u01b0\u1eddng ph\u00f9 do t\u00edch t\u1ee5 n\u01b0\u1edbc v\u00e0 ch\u1ea5t th\u1ea3i trong c\u01a1 th\u1ec3, c\u0169ng nh\u01b0 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111i\u1ec7n gi\u1ea3i v\u00e0 n\u1ed3ng \u0111\u1ed9 mu\u1ed1i trong c\u01a1 th\u1ec3. M\u1eb7c d\u00f9 r\u1ea5t nhi\u1ec1u c\u01a1 ch\u1ebf \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t \u0111\u1ec3 l\u00fd gi\u1ea3i nh\u1eefng v\u1eabn ch\u01b0a c\u00f3 s\u1ef1 th\u1ed1ng nh\u1ea5t n\u00ean vi\u1ec7c hi\u1ec3u v\u1ec1 c\u00e1c c\u01a1 ch\u1ebf g\u00e2y ph\u00f9 s\u1ebd gi\u00fap vi\u1ec7c \u0111i\u1ec1u tr\u1ecb ph\u00f9 tr\u1edf n\u00ean hi\u1ec7u qu\u1ea3,v\u00e0 gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

        T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong>:<\/p>\n

        References<\/p>\n

        [1]<\/p>\n

        Nguy\u1ec5n Ng\u1ecdc Lan Anh, Hu\u1ef3nh Ng\u1ecdc Ph\u01b0\u01a1ng Th\u1ea3o. Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n b\u1ec7nh n\u1ed9i khoa. Nh\u00e0 xu\u1ea5t b\u1ea3n \u0110\u1ea1i h\u1ecdc Qu\u1ed1c gia Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh<\/em>, 2023: 269-270.<\/p>\n

        [2]<\/p>\n

        Nguy\u1ec5n Nh\u01b0 Ngh\u0129a. T\u00e0i li\u1ec7u N\u1ed9i th\u1eadn – Ti\u1ebft ni\u1ec7u (D\u00e0nh cho h\u1ecdc vi\u00ean sau \u0110\u1ea1i h\u1ecdc). B\u1ed9 m\u00f4n N\u1ed9i Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c C\u1ea7n Th\u01a1<\/em>, 2018: 4-5.<\/p>\n

        [3]<\/p>\n

        Demetrius Ellis. Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome. Pediatric Nephrology, <\/em>2016.<\/p>\n","protected":false},"excerpt":{"rendered":"

        Ph\u00f9 l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng ph\u1ed5 bi\u1ebfn trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0. Ph\u00f9 th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n tr\u00ean c\u01a1 th\u1ec3, ch\u1ee7 y\u1ebfu \u1edf v\u00f9ng ch\u00e2n, m\u1eaft, tay v\u00e0 b\u1ee5ng. Tuy nhi\u00ean, c\u01a1 ch\u1ebf c\u1ee7a ph\u00f9 trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 ch\u01b0a th\u1eadt s\u1ef1 r\u00f5 r\u00e0ng. Trong b\u00e0i vi\u1ebft n\u00e0y s\u1ebd tr\u00ecnh b\u00e0y m\u1ed9t s\u1ed1 tranh lu\u1eadn […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[3],"yoast_head":"\nC\u01a1 ch\u1ebf ph\u00f9 trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng m\u1ea5t protein qua n\u01b0\u1edbc ti\u1ec3u > 3 g protein\/ng\u00e0y ho\u1eb7c \u2265 3.5 g\/1.73m2 da\/24h\" \/>\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=\"C\u01a1 ch\u1ebf ph\u00f9 trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 - 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