{"id":22300,"date":"2023-04-16T15:05:27","date_gmt":"2023-04-16T08:05:27","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22300"},"modified":"2023-04-18T15:03:17","modified_gmt":"2023-04-18T08:03:17","slug":"dieu-tri-suy-tim-cap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/dieu-tri-suy-tim-cap\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb suy tim c\u1ea5p: m\u1ee5c ti\u00eau, nguy\u00ean t\u1eafc v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p"},"content":{"rendered":"<p><strong>Suy tim l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng c\u00f3 nguy\u00ean nh\u00e2n b\u1ec7nh h\u1ecdc \u0111a d\u1ea1ng, d\u1eabn \u0111\u1ebfn bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac, ch\u1ee9c n\u0103ng c\u1ee7a tim. K\u1ebft qu\u1ea3 l\u00e0 \u00e1p l\u1ef1c trong bu\u1ed3ng tim t\u0103ng cao, cung l\u01b0\u1ee3ng tim gi\u1ea3m. Khi suy tim di\u1ec5n bi\u1ebfn n\u1eb7ng l\u00ean c\u00f2n g\u1ecdi l\u00e0 suy tim \u201cm\u1ea5t b\u00f9\u201d th\u01b0\u1eddng khi\u1ebfn b\u1ec7nh nh\u00e2n ph\u1ea3i nh\u1eadp vi\u1ec7n v\u00e0 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, giai \u0111o\u1ea1n n\u00e0y ng\u01b0\u1eddi ta \u0111\u1ecbnh ngh\u0129a l\u00e0 suy tim c\u1ea5p. B\u00e0i vi\u1ebft sau ch\u00fang t\u00f4i s\u1ebd tr\u00ecnh b\u00e0y v\u1ec1 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb suy tim c\u1ea5p theo h\u01b0\u1edbng d\u1eabn m\u1edbi nh\u1ea5t c\u1ee7a B\u1ed9 y t\u1ebf.<\/strong><\/p>\n<h1>1. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/h1>\n<ul>\n<li>Giai \u0111o\u1ea1n c\u1ea5p: x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n suy tim c\u1ea5p, gi\u1ea3m tri\u1ec7u ch\u1ee9ng, c\u1ea3i thi\u1ec7n sung huy\u1ebft v\u00e0 t\u01b0\u1edbi m\u00e1u t\u1ea1ng, ph\u1ee5c h\u1ed3i \u00f4xy, h\u1ea1n ch\u1ebf t\u1ed5n th\u01b0\u01a1ng t\u1ea1ng (tim, th\u1eadn, gan, ru\u1ed9t\u2026) v\u00e0 ph\u00f2ng ng\u1eeba huy\u1ebft kh\u1ed1i.<\/li>\n<li>Giai \u0111o\u1ea1n b\u00e1n c\u1ea5p: x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n suy tim c\u1ea5p, c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u suy tim, h\u1ea1n ch\u1ebf t\u1ed5n th\u01b0\u01a1ng t\u1ea1ng, ph\u00f2ng ng\u1eeba huy\u1ebft kh\u1ed1i.<\/li>\n<li>\u00a0Tr\u01b0\u1edbc khi ra vi\u1ec7n v\u00e0 theo d\u00f5i l\u00e2u d\u00e0i: c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng, c\u1ea3i thi\u1ec7n sung huy\u1ebft h\u1ec7 th\u1ed1ng, ph\u00f2ng ng\u1eeba t\u00e1i nh\u1eadp vi\u1ec7n s\u1edbm, c\u1ea3i thi\u1ec7n t\u1eed vong.<\/li>\n<\/ul>\n<h2>2. Nguy\u00ean t\u1eafc chung trong \u0111i\u1ec1u tr\u1ecb suy tim c\u1ea5p<\/h2>\n<ul>\n<li>\u0110i\u1ec1u tr\u1ecb c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t: t\u1ea1i th\u1eddi \u0111i\u1ec3m nh\u1eadp vi\u1ec7n, x\u1eed tr\u00ed ngay n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n h\u1ed7 tr\u1ee3 th\u00f4ng kh\u00ed, tu\u1ea7n ho\u00e0n.<\/li>\n<li>Sau \u0111\u00f3 ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u theo nguy\u00ean nh\u00e2n ho\u1eb7c c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb chuy\u00ean bi\u1ec7t theo c\u00e1c b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng kh\u00e1c nhau.<\/li>\n<li>X\u00e1c \u0111\u1ecbnh s\u1edbm nguy\u00ean nh\u00e2n v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y suy tim c\u1ea5p: t\u1ed1t nh\u1ea5t trong v\u00f2ng 60 \u2013 120 ph\u00fat k\u1ec3 t\u1eeb khi ng\u01b0\u1eddi b\u1ec7nh nh\u1eadp vi\u1ec7n.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb d\u1ef1a theo c\u00e1c d\u1ea5u hi\u1ec7u\/tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng.<\/li>\n<li>Theo d\u00f5i s\u00e1t t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 thay \u0111\u1ed5i ph\u00e1c \u0111\u1ed3 x\u1eed tr\u00ed k\u1ecbp th\u1eddi.<\/li>\n<\/ul>\n<h3>3. Nh\u1eefng t\u00ecnh hu\u1ed1ng c\u1ea7n chuy\u1ec3n ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ebfn \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c ho\u1eb7c ch\u0103m s\u00f3c tim m\u1ea1ch \u0111\u1eb7c bi\u1ec7t<\/h3>\n<ul>\n<li>B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n ho\u1eb7c c\u00f3 nguy c\u01a1 ph\u1ea3i \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n.<\/li>\n<li>D\u1ea5u hi\u1ec7u\/tri\u1ec7u ch\u1ee9ng c\u1ee7a gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4.<\/li>\n<li>SpO2 &lt; 90% (d\u00f9 \u0111ang h\u1ed7 tr\u1ee3 b\u1eb1ng li\u1ec7u ph\u00e1p \u00f4xy).<\/li>\n<li>Co k\u00e9o c\u00e1c c\u01a1 h\u00f4 h\u1ea5p ho\u1eb7c t\u1ea7n s\u1ed1 th\u1edf &gt; 25 chu k\u00ec\/ph\u00fat<\/li>\n<li>\u00a0T\u1ea7n s\u1ed1 tim &lt; 40 ho\u1eb7c &gt; 130 chu k\u00ec\/ph\u00fat<\/li>\n<li>\u00a0Huy\u1ebft \u00e1p t\u00e2m thu \u0111\u1ed9ng m\u1ea1ch &lt; 90 mmHg<\/li>\n<\/ul>\n<h4>4. C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3<\/h4>\n<h5>4.1.Li\u1ec7u ph\u00e1p oxy<\/h5>\n<ul>\n<li>Ch\u1ec9 \u0111\u1ecbnh th\u1edf oxy khi SpO2 &lt; 90% ho\u1eb7c PaO2 &lt; 60 mmHg.<\/li>\n<li>Th\u00f4ng kh\u00ed kh\u00f4ng x\u00e2m nh\u1eadp \u00e1p l\u1ef1c d\u01b0\u01a1ng: gi\u00fap c\u1ea3i thi\u1ec7n suy h\u00f4 h\u1ea5p, t\u0103ng oxy ho\u00e1 m\u00e1u, gi\u1ea3m PaCO2 v\u00e0 c\u1ea3i thi\u1ec7n pH m\u00e1u \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi th\u1edf oxy k\u00ednh m\u0169i ho\u1eb7c mask t\u00fai kh\u00f4ng \u0111\u00e1p \u1ee9ng.<\/li>\n<li>\u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 th\u1edf m\u00e1y x\u00e2m nh\u1eadp: khi ng\u01b0\u1eddi b\u1ec7nh suy h\u00f4 h\u1ea5p ti\u1ebfn tri\u1ec3n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi oxy li\u1ec7u ph\u00e1p ho\u1eb7c kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp \u00e1p l\u1ef1c d\u01b0\u01a1ng.<\/li>\n<\/ul>\n<h5>4.2.Thu\u1ed1c l\u1ee3i ti\u1ec3u<\/h5>\n<p>Thu\u1ed1c l\u1ee3i ti\u1ec3u quai furosemid l\u00e0 n\u1ec1n t\u1ea3ng trong \u0111i\u1ec1u tr\u1ecb suy tim sung huy\u1ebft. Thu\u1ed1c l\u1ee3i ti\u1ec3u quai n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t sau khi c\u00f3 ch\u1ea9n \u0111o\u00e1n suy tim.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter\" src=\"https:\/\/scontent.fhan3-1.fna.fbcdn.net\/v\/t1.15752-9\/341516252_907782493824362_1331702007981588460_n.png?_nc_cat=106&amp;ccb=1-7&amp;_nc_sid=ae9488&amp;_nc_ohc=3DGao7FnLSIAX8UisXT&amp;_nc_ht=scontent.fhan3-1.fna&amp;oh=03_AdQEyFbTz2GaSk1qEMOapzQW9GjB1wEhNLS1YghiUSFddA&amp;oe=64631BA9\" alt=\"suy tim c\u1ea5p\" width=\"545\" height=\"520\" \/><br \/>\na: Li\u1ec1u t\u1ed1i \u0111a h\u00e0ng ng\u00e0y c\u1ee7a l\u1ee3i ti\u1ec3u quai (t\u0129nh m\u1ea1ch) th\u01b0\u1eddng 400 \u2013 600 mg, c\u00f3 th\u1ec3 l\u00ean \u0111\u1ebfn 1.000 mg \u1edf b\u1ec7nh nh\u00e2n suy ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng.<\/p>\n<p>b: \u0110i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p th\u00eam v\u00e0o v\u1edbi l\u1ee3i ti\u1ec3u quai c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u t\u00e1c \u0111\u1ed9ng \u1edf nh\u1eefng v\u1ecb tr\u00ed kh\u00e1c nhau tr\u00ean th\u1eadn.<\/p>\n<p>C: C\u00f3, K: Kh\u00f4ng<\/p>\n<h5>4.3.Thu\u1ed1c d\u00e3n m\u1ea1ch<\/h5>\n<p>Thu\u1ed1c d\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p suy tim c\u1ea5p do c\u01a1n t\u0103ng huy\u1ebft \u00e1p ho\u1eb7c suy tim c\u1ea5p c\u00f3 huy\u1ebft \u00e1p t\u00e2m thu \u2265 110 mmHg. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00e1c, vai tr\u00f2 c\u1ee7a thu\u1ed1c d\u00e3n m\u1ea1ch kh\u00f4ng t\u1ed1t h\u01a1n so v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng quy b\u1eb1ng l\u1ee3i ti\u1ec3u quai \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch.<\/p>\n<p>C\u1ea7n theo d\u00f5i huy\u1ebft \u00e1p, t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng khi s\u1eed d\u1ee5ng thu\u1ed1c d\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng t\u0129nh<br \/>\nm\u1ea1ch.<\/p>\n<h5>4.4.Thu\u1ed1c t\u0103ng co b\u00f3p c\u01a1 tim v\u00e0 thu\u1ed1c t\u0103ng co m\u1ea1ch<\/h5>\n<ul>\n<li>M\u1ee5c \u0111\u00edch s\u1eed d\u1ee5ng: c\u1ea3i thi\u1ec7n t\u01b0\u1edbi m\u00e1u c\u00e1c c\u01a1 quan, n\u00e2ng huy\u1ebft \u00e1p.<\/li>\n<li>Thu\u1ed1c t\u0103ng co b\u00f3p c\u01a1 tim v\u00e0 thu\u1ed1c t\u0103ng co m\u1ea1ch \u0111\u01b0\u1ee3c xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh trong th\u1eddi gian ng\u1eafn,\u00a0s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c n\u00e0y trong th\u1eddi gian d\u00e0i c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 g\u00e2y t\u1ed5n<br \/>\nth\u01b0\u01a1ng c\u01a1 tim.<\/li>\n<li>N\u00ean ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c s\u1edbm khi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 t\u1ee5t huy\u1ebft \u00e1p ho\u1eb7c c\u00f3 d\u1ea5u hi\u1ec7u gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4 trong khi \u0111\u1ee7 kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n.<\/li>\n<li>Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh th\u01b0\u1eddng quy c\u00e1c thu\u1ed1c t\u0103ng co b\u00f3p c\u01a1 tim v\u00e0 thu\u1ed1c t\u0103ng co m\u1ea1ch.<\/li>\n<li>N\u00ean s\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p thu\u1ed1c t\u0103ng co b\u00f3p c\u01a1 tim k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c t\u0103ng co m\u1ea1ch h\u01a1n l\u00e0 t\u0103ng li\u1ec1u \u0111\u01a1n \u0111\u1ed9c m\u1ed9t thu\u1ed1c.<\/li>\n<li>Noradrenalin c\u00f3 th\u1ec3 \u01b0u th\u1ebf h\u01a1n so v\u1edbi dopamin trong tr\u01b0\u1eddng h\u1ee3p s\u1ed1c tim.<\/li>\n<\/ul>\n<h5>4.5.Digoxin<\/h5>\n<p>Ch\u1ec9 \u0111\u1ecbnh khi b\u1ec7nh nh\u00e2n suy tim c\u1ea5p c\u00f3 rung nh\u0129 \u0111\u00e1p \u1ee9ng t\u1ea7n s\u1ed1 th\u1ea5t nhanh (&gt;110 CK\/ph\u00fat).<\/p>\n<p>Li\u1ec1u l\u01b0\u1ee3ng: n\u1ebfu b\u1ec7nh nh\u00e2n ch\u01b0a s\u1eed d\u1ee5ng digoxin tr\u01b0\u1edbc \u0111\u00f3 th\u00ec c\u00f3 th\u1ec3 ti\u00eam lu\u00f4n t\u0129nh m\u1ea1ch 0,25 \u2013 0,5mg digoxin. N\u1ebfu b\u1ec7nh nh\u00e2n cao tu\u1ed5i ho\u1eb7c c\u00f3 b\u1ec7nh n\u1ed9i khoa k\u00e8m theo th\u00ec c\u1ea7n c\u00e2n nh\u1eafc d\u00f9ng li\u1ec1u digoxin.<\/p>\n<h5>4.6.Morphin<\/h5>\n<p>Kh\u00f4ng s\u1eed d\u1ee5ng morphin th\u01b0\u1eddng quy trong \u0111i\u1ec1u tr\u1ecb suy tim c\u1ea5p do thu\u1ed1c l\u00e0m t\u0103ng nguy c\u01a1 th\u1edf m\u00e1y x\u00e2m nh\u1eadp, t\u0103ng nguy c\u01a1 t\u1eed vong t\u1ea1i vi\u1ec7n v\u00e0 t\u0103ng nguy c\u01a1 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n.<\/p>\n<p>Morphin ch\u1ec9 n\u00ean c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh kh\u00f3 th\u1edf ho\u1eb7c \u0111au nhi\u1ec1u v\u00e0 kh\u00f4ng c\u1ea3i thi\u1ec7n b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c.<\/p>\n<h5>4.7. H\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n c\u01a1 h\u1ecdc ng\u1eafn ng\u00e0y<\/h5>\n<p>C\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 c\u01a1 h\u1ecdc ng\u1eafn ng\u00e0y g\u1ed3m:<a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/tim-hieu-ve-ky-thuat-ecmo-tim-phoi-nhan-tao\/\"> ECMO<\/a>, IABP, LVAD\u2026 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh nh\u01b0 l\u00e0 bi\u1ec7n ph\u00e1p b\u1eafc c\u1ea7u n\u1ed1i ch\u1edd c\u00e1c can thi\u1ec7p t\u00edch c\u1ef1c h\u01a1n ho\u1eb7c ch\u1edd c\u01a1 tim h\u1ed3i ph\u1ee5c.<\/p>\n<p>\u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p s\u1ed1c tim ho\u1eb7c suy tim n\u1eb7ng k\u00e9m \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa th\u01b0\u1eddng quy.<\/p>\n<h5>4.8. Thay th\u1ebf th\u1eadn<\/h5>\n<p>Si\u00eau l\u1ecdc th\u1eadn (CRRT: continuous renal replacement therapy) kh\u00f4ng khuy\u1ebfn c\u00e1o th\u01b0\u1eddng quy, th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u, t\u0103ng kali m\u00e1u n\u1eb7ng (&gt; 6,5 mmol\/L), toan m\u00e1u n\u1eb7ng (pH &lt; 7,2), urea &gt; 25 mmol\/L v\u00e0 creatinine m\u00e1u &gt; 300 umol\/L.<\/p>\n<h5>4.9.Ph\u00f2ng ng\u1eeba thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch<\/h5>\n<p>D\u1ef1 ph\u00f2ng thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch b\u1eb1ng Heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p ho\u1eb7c c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng kh\u00e1c tr\u1eeb khi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/p>\n<h5>4.10.\u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt ho\u1eb7c can thi\u1ec7p<\/h5>\n<p>N\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t khi:<\/p>\n<ul>\n<li>H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p c\u00f3 bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc (h\u1edf van hai l\u00e1 c\u1ea5p, th\u1ee7ng tim, th\u1ee7ng v\u00e1ch li\u00ean th\u1ea5t): b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh \u0111\u1ed3ng th\u1eddi s\u1eeda ch\u1eefa bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc<\/li>\n<li>H\u1edf van tim c\u1ea5p: s\u1eeda van ho\u1eb7c thay van tim nh\u00e2n t\u1ea1o<\/li>\n<li>H\u1eb9p van hai l\u00e1 kh\u00edt: nong van hai l\u00e1 b\u1eb1ng b\u00f3ng qua da.<\/li>\n<li>H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u1eb7ng: thay van \u0110MC qua da ho\u1eb7c nong van \u0110MC t\u1ea1m th\u1eddi<br \/>\ntrong l\u00fac ch\u1edd thay van.<\/li>\n<li>R\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm: \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp t\u1ea1m th\u1eddi.<\/li>\n<\/ul>\n<h5>4.11.\u0110\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi ra vi\u1ec7n v\u00e0 k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb sau khi ra vi\u1ec7n<\/h5>\n<ul>\n<li>\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng g\u1ea7n \u1edf ng\u01b0\u1eddi b\u1ec7nh suy tim c\u1ea5p.<\/li>\n<li>Kh\u1edfi tr\u1ecb SGLT2i s\u1edbm cho c\u00e1c b\u1ec7nh nh\u00e2n suy tim c\u1ea5p giai \u0111o\u1ea1n \u1ed5n \u0111\u1ecbnh tr\u01b0\u1edbc khi ra\u00a0 vi\u1ec7n k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ee9ng minh gi\u1ea3m s\u1edbm t\u1ed5ng bi\u1ebfn c\u1ed1 tim m\u1ea1ch g\u1ed3m t\u1eed vong, suy tim v\u00e0 c\u1ea3i thi\u1ec7n thang \u0111i\u1ec3m ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.<\/li>\n<li>Kh\u1edfi tr\u1ecb ARNI (sacubitril\/valsartan) \u1edf c\u00e1c b\u1ec7nh nh\u00e2n suy tim c\u1ea5p c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m giai \u0111o\u1ea1n \u1ed5n \u0111\u1ecbnh tr\u01b0\u1edbc khi ra vi\u1ec7n \u0111\u01b0\u1ee3c ch\u1ee9ng minh gi\u1ea3m NT-proBNP.<\/li>\n<li>Xem x\u00e9t kh\u1edfi tr\u1ecb s\u1edbm ch\u1eb9n beta giao c\u1ea3m giao c\u1ea3m v\u1edbi li\u1ec1u l\u01b0\u1ee3ng th\u1ea5p khi l\u00e2m s\u00e0ng kh\u00f4ng c\u00f2n c\u00e1c d\u1ea5u hi\u1ec7u sung huy\u1ebft.<\/li>\n<li>C\u00f3 k\u1ebf ho\u1ea1ch h\u1eb9n kh\u00e1m l\u1ea1i s\u1edbm (sau 1- 2 tu\u1ea7n) \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n suy tim c\u1ea5p sau khi ra vi\u1ec7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 l\u1ea1i c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a suy tim, t\u00ecnh tr\u1ea1ng sung huy\u1ebft, huy\u1ebft \u00e1p, t\u1ea7n s\u1ed1 tim c\u0169ng nh\u01b0 l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng gan, th\u1eadn, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 v\u00e0 c\u00f3 th\u1ec3 peptide l\u1ee3i ti\u1ec3u.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Suy tim l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng c\u00f3 nguy\u00ean nh\u00e2n b\u1ec7nh h\u1ecdc \u0111a d\u1ea1ng, d\u1eabn \u0111\u1ebfn bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac, ch\u1ee9c n\u0103ng c\u1ee7a tim. K\u1ebft qu\u1ea3 l\u00e0 \u00e1p l\u1ef1c trong bu\u1ed3ng tim t\u0103ng cao, cung l\u01b0\u1ee3ng tim gi\u1ea3m. Khi suy tim di\u1ec5n bi\u1ebfn n\u1eb7ng l\u00ean c\u00f2n g\u1ecdi l\u00e0 suy tim \u201cm\u1ea5t b\u00f9\u201d th\u01b0\u1eddng khi\u1ebfn [&hellip;]<\/p>\n","protected":false},"author":36,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u0110i\u1ec1u tr\u1ecb suy tim c\u1ea5p: m\u1ee5c ti\u00eau, nguy\u00ean t\u1eafc v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p - Vinmec<\/title>\n<meta name=\"description\" content=\"Suy tim l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng c\u00f3 nguy\u00ean nh\u00e2n b\u1ec7nh h\u1ecdc \u0111a d\u1ea1ng, d\u1eabn \u0111\u1ebfn bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac, ch\u1ee9c n\u0103ng c\u1ee7a tim. 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