{"id":24373,"date":"2023-04-18T22:33:27","date_gmt":"2023-04-18T15:33:27","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24373"},"modified":"2023-04-19T09:58:43","modified_gmt":"2023-04-19T02:58:43","slug":"chan-doan-va-dieu-tri-benh-thap-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/chan-doan-va-dieu-tri-benh-thap-tim\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u1ea5p tim"},"content":{"rendered":"

Th\u1ea5p tim l\u00e0 b\u1ec7nh vi\u00eam lan t\u1ecfa c\u00e1c t\u1ed5 ch\u1ee9c li\u00ean k\u1ebft, c\u00e1c c\u01a1 quan th\u01b0\u1eddng b\u1ecb t\u1ed5n th\u01b0\u01a1ng l\u00e0 tim, kh\u1edbp, h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, da v\u00e0 t\u1ed5 ch\u1ee9c d\u01b0\u1edbi da. Trong \u0111\u00f3 t\u1ed5n th\u01b0\u01a1ng tim quan tr\u1ecdng nh\u1ea5t v\u00ec c\u00f3 th\u1ec3 \u0111\u01b0a \u0111\u1ebfn t\u1eed vong trong giai \u0111o\u1ea1n c\u1ea5p c\u1ee7a b\u1ec7nh ho\u1eb7c c\u00f3 th\u1ec3 th\u00e0nh s\u1eb9o l\u00e0m bi\u1ebfn d\u1ea1ng van tim \u0111\u01b0a \u0111\u1ebfn b\u1ec7nh tim do th\u1ea5p<\/a>.
\nB\u1ec7nh c\u00f3 li\u00ean quan \u0111\u1ebfn qu\u00e1 tr\u00ecnh vi\u00eam nhi\u1ec5m \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean (vi\u00eam h\u1ecdng, vi\u00eam amygdales) do li\u00ean c\u1ea7u khu\u1ea9n beta tan m\u00e1u nh\u00f3m A g\u00e2y ra.<\/strong><\/p>\n

\"minh-hoa-thap-tim\"<\/p>\n

\u00a01. Sinh b\u1ec7nh h\u1ecdc v\u00e0 nguy\u00ean nh\u00e2n<\/strong><\/h2>\n

1.1\u00a0 Sinh b\u1ec7nh h\u1ecdc<\/strong><\/h3>\n

T\u1ed5n th\u01b0\u01a1ng vi\u00eam nhi\u1ec5m t\u00ecm th\u1ea5y \u1edf nhi\u1ec1u n\u01a1i tr\u00ean c\u01a1 th\u1ec3, ch\u1ee7 y\u1ebfu l\u00e0 tim, n\u00e3o, kh\u1edbp v\u00e0 da.<\/span><\/p>\n

Vi\u00eam tim do th\u1ea5p l\u00e0 vi\u00eam tim to\u00e0n b\u1ed9: m\u00e0ng ngo\u00e0i tim, c\u01a1 tim, v\u00e0 n\u1ed9i m\u1ea1c c\u01a1 tim. 2 th\u00e0nh ph\u1ea7n quan tr\u1ecdng l\u00e0 van tim v\u00e0 c\u01a1 tim. S\u1ee9c co b\u00f3p c\u1ee7a tim hi\u1ebfm khi gi\u1ea3m v\u00e0 troponin h\u1ea7u nh\u01b0 kh\u00f4ng t\u0103ng. Van tim b\u1ecb t\u1ed5n th\u01b0\u01a1ng do qu\u00e1 tr\u00ecnh vi\u00eam t\u1ea1o n\u1ed1t x\u01a1 tr\u00ean b\u1ec1 m\u1eb7t van tim v\u00e0 c\u00e1c th\u00e0nh ph\u1ea7n d\u00e2y ch\u1eb1ng, v\u00f2ng van c\u0169ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng g\u00e2y gi\u00e3n hay b\u1ecb k\u00e9o c\u0103ng. Van 2 l\u00e1 l\u00e0 \u1ea3nh h\u01b0\u1edfng n\u1eb7ng n\u1ec1 nh\u1ea5t ti\u1ebfp theo l\u00e0 van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, van 3 l\u00e1 v\u00e0 van ph\u1ed5i r\u1ea5t hi\u1ebfm khi b\u1ecb t\u1ed5n th\u01b0\u01a1ng.<\/span><\/p>\n

Th\u1ec3 Aschoff tr\u00ean m\u00f4 c\u01a1 tim \u1edf nh\u0129 l\u00e0 \u0111\u1eb7c tr\u01b0ng cho b\u1ec7nh th\u1ea5p. bao g\u1ed3m: ph\u00f9 n\u1ec1, s\u1ee3i collagen, v\u00e0 thay \u0111\u1ed5i \u0111\u1eb7c tr\u01b0ng c\u1ee7a m\u00f4 li\u00ean k\u1ebft<\/span><\/p>\n

1.2\u00a0 Nguy\u00ean nh\u00e2n<\/strong><\/h3>\n

Nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh th\u1ea5p tim l\u00e0 do li\u00ean c\u1ea7u khu\u1ea9n ( tan m\u00e1u nh\u00f3m A (LCK)<\/span>
\n<\/span> B\u1eb1ng c\u00e1c ph\u1ea3n \u1ee9ng huy\u1ebft thanh \u0111\u1eb7c hi\u1ec7u, ng\u01b0\u1eddi ta \u0111\u00e3 ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c tr\u00ean 80 t\u00fdp kh\u00e1c nhau c\u1ee7a<\/span> LCK nh\u00f3m A, trong \u0111\u00f3 c\u00f3 10 tu\u00fdp hay g\u1eb7p l\u00e0\u00a0 t\u00fdp 1, 3, 5, 6, 14, 18, 19, 24, 27, 29.<\/span>
\n<\/span> T\u1ed5n th\u01b0\u01a1ng kh\u1edfi \u0111\u1ea7u c\u1ee7a LCK nh\u00f3m A l\u00e0 vi\u00eam h\u1ecdng, vi\u00eam amygdales, c\u00f3 th\u1ec3 g\u00e2y b\u1ec7nh th\u1ea5p<\/span> tim. C\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u1edfi \u0111\u1ea7u \u1edf da do LCK kh\u00f4ng g\u00e2y n\u00ean b\u1ec7nh th\u1ea5p tim.<\/span><\/p>\n

\u00a02. Ch\u1ea9n \u0111o\u00e1n b\u1ec7nh th\u1ea5p tim<\/strong><\/h2>\n

Ch\u1ea9n \u0111o\u00e1n theo ti\u00eau chu\u1ea9n Jones.<\/span><\/p>\n

Ti\u00eau chu\u1ea9n n\u00e0y \u0111\u01b0\u1ee3c chia th\u00e0nh 3 nh\u00f3m:<\/span><\/p>\n

Nh\u00f3m 1: Bi\u1ec3u hi\u1ec7n ch\u00ednh<\/strong><\/p>\n

    \n
  • Vi\u00eam tim<\/span><\/li>\n
  • Vi\u00eam\u00a0 kh\u1edbp<\/li>\n
  • M\u00faa v\u1eddn<\/li>\n
  • H\u1ed3ng ban<\/li>\n
  • N\u1ed1t : d\u01b0\u1edbi da<\/li>\n<\/ul>\n

    Nh\u00f3m 2: Bi\u1ec3u hi\u1ec7n ph\u1ee5<\/strong><\/p>\n

      \n
    • L\u00e2m s\u00e0ng: \u0110au kh\u1edbp, S\u1ed1t<\/span><\/li>\n
    • \u00a0C\u1eadn l\u00e2m s\u00e0ng: CRP, VS t\u0103ng, PR k\u00e9o d\u00e0i<\/li>\n<\/ul>\n

      Nh\u00f3m 3:<\/strong> B\u1eb1ng ch\u1ee9ng nhi\u1ec5m li\u00ean c\u1ea7u nh\u00f3m A tr\u01b0\u1edbc \u0111\u00f3:<\/span><\/p>\n

        \n
      • C\u1ea5y d\u1ecbch h\u1ecdng hay test nhanh kh\u00e1ng nguy\u00ean li\u00ean c\u1ea7u<\/span><\/li>\n
      • T\u0103ng hay gia t\u0103ng n\u1ed3ng \u0111\u1ed9 kh\u00e1ng th\u1ec3 ch\u1ed1ng li\u00ean c\u1ea7u<\/li>\n<\/ul>\n

        Ch\u1ea9n \u0111o\u00e1n th\u1ea5p khi c\u00f3 b\u1eb1ng ch\u1ee9ng<\/strong> nhi\u1ec5m li\u00ean c\u1ea7u v\u00e0: 2 tri\u1ec7u ch\u1ee9ng ch\u00ednh<\/strong> hay 1 ch\u00ednh v\u00e0 2 ph\u1ee5.<\/strong><\/span><\/p>\n

        2.1\u00a0 B\u1ec7nh s\u1eed:<\/strong><\/h3>\n
          \n
        • Ti\u1ec1n c\u0103n vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u, 1-5 tu\u1ea7n (trung b\u00ecnh 3 tu\u1ea7n). Th\u1eddi gian \u1ee7 b\u1ec7nh c\u00f3 th\u1ec3\u00a0 2-6 th\u00e1ng (m\u00faa v\u1eddn).<\/span><\/li>\n
        • \u00a0M\u1ec7t m\u1ecfi, xanh xao v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c nh\u01b0 ch\u1ea3y m\u00e1u m\u0169i (5-10%) v\u00e0 \u0111au b\u1ee5ng.<\/li>\n
        • Ti\u1ec1n c\u0103n gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi b\u1ecb th\u1ea5p.<\/li>\n<\/ul>\n

          2.2\u00a0 Bi\u1ec3u hi\u1ec7n ch\u00ednh:<\/strong><\/h3>\n
            \n
          • \u00a0 \u00a0 \u00a0 <\/span>Vi\u00eam kh\u1edbp:<\/span><\/li>\n<\/ul>\n

            Th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a th\u1ea5p (70%), li\u00ean quan \u0111\u1ebfn kh\u1edbp l\u1edbn (g\u1ed1i, c\u1ed5 ch\u00e2n, khu\u1ef7u, c\u1ed5 tay), nhi\u1ec1u kh\u1edbp x\u1ea3y ra c\u00f9ng l\u00fac hay di chuy\u1ec3n. N\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng Salicylate, tri\u1ec7u ch\u1ee9ng c\u1ea3i thi\u1ec7n r\u1ea5t nhanh, sau 48 gi\u1edd kh\u00f4ng gi\u1ea3m th\u00ec kh\u00f4ng ngh\u0129 \u0111\u1ebfn th\u1ea5p. T\u1ef1 h\u1ebft trong v\u00f2ng 7-10 ng\u00e0y<\/span><\/p>\n

              \n
            • \u00a0 \u00a0 \u00a0 <\/span>Vi\u00eam tim:<\/span><\/li>\n<\/ul>\n

              X\u1ea3y ra 50 %. Tim nhanh (kh\u00f4ng t\u01b0\u01a1ng \u1ee9ng v\u1edbi s\u1ed1t). N\u1ebfu kh\u00f4ng,\u00a0 \u00edt ngh\u0129 \u0111\u1ebfn vi\u00eam tim. \u00c2m th\u1ed5i c\u1ee7a h\u1edf 2 l\u00e1, h\u1edf ch\u1ee7 do vi\u00eam van tim. T\u1ed5n th\u01b0\u01a1ng k\u00e9o d\u00e0i v\u00e0 l\u1eb7p \u0111i l\u1eb7p l\u1ea1i d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng m\u1ea1n t\u00ednh, kh\u00f4ng h\u1ed3i ph\u1ee5c g\u00e2y h\u1eb9p h\u1edf van tim.<\/span><\/p>\n

                \n
              • \u00a0 <\/span> Vi\u00eam m\u00e0ng ngo\u00e0i tim: ti\u1ebfng c\u1ecd m\u00e0ng tim, tr\u00e0n d\u1ecbch, \u0111au ng\u1ef1c v\u00e0 thay \u0111\u1ed5i ECG. Th\u01b0\u1eddng ph\u1ea3i k\u1ebft h\u1ee3p vi\u00eam van tim v\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng tim th\u01b0\u1eddng kh\u00f4ng \u0111\u00e1ng k\u1ec3 v\u00e0 h\u1ea7u nh\u01b0 kh\u00f4ng g\u00e2y ch\u00e8n \u00e9p tim.<\/span><\/li>\n
              • \u00a0 \u00a0 \u00a0 <\/span>H\u1ed3ng ban v\u00f2ng:<\/span><\/li>\n<\/ul>\n

                10% th\u1ea5p kh\u1edbp c\u1ea5p, kh\u00f4ng ng\u1ee9a ,ch\u1ee7 y\u1ebfu \u1edf th\u00e2n m\u00ecnh v\u00e0 ph\u1ea7n g\u1ea7n m\u1eb7t trong c\u1ee7a c\u00e1c chi, kh\u00f4ng bao gi\u1edd tr\u00ean m\u1eb7t. Rash mau phai bi\u1ebfn m\u1ea5t khi ti\u1ebfp x\u00fac l\u1ea1nh v\u00e0 t\u00e1i xu\u1ea5t hi\u1ec7n khi ti\u1ebfp x\u00fac v\u1edbi nhi\u1ec7t.<\/span><\/p>\n

                  \n
                • \u00a0 \u00a0 \u00a0 <\/span>N\u1ed1t d\u01b0\u1edbi da:<\/span><\/li>\n<\/ul>\n

                  2-10%, \u0111\u1eb7c bi\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p t\u00e1i ph\u00e1t, kh\u00f4ng xu\u1ea5t hi\u1ec7n 1 m\u00ecnh. K\u00edch th\u01b0\u1edbc 0.2-2cm di \u0111\u1ed9ng, c\u1ee9ng kh\u00f4ng \u0111au, kh\u00f4ng ng\u1ee9a, \u0111\u1ed1i x\u1ee9ng, \u0111\u01a1n \u0111\u1ed9c hay t\u1eebng ch\u00f9m \u1edf b\u1ec1 m\u1eb7t du\u1ed7i c\u1ee7a c\u00e1c kh\u1edbp. Xu\u1ea5t hi\u1ec7n k\u00e9o d\u00e0i v\u00e0 hay k\u1ebft h\u1ee3p v\u1edbi vi\u00eam tim. X\u1ea3y ra 10% vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p hay l\u00e0 n\u1ed1t d\u01b0\u1edbi da l\u00e0nh t\u00ednh \u1edf tr\u1ebb em v\u00e0 ng\u01b0\u1eddi l\u1edbn<\/span><\/p>\n

                    \n
                  • \u00a0 \u00a0 \u00a0 <\/span>M\u00faa v\u1eddn Sydenham:<\/span><\/li>\n<\/ul>\n

                    15% b\u1ec7nh nh\u00e2n. Ch\u1ee7 y\u1ebfu \u1edf tr\u1ebb g\u00e1i (8-12 tu\u1ed5i). R\u1ed1i lo\u1ea1n th\u1ea7n kinh (m\u00faa v\u1eddn, gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c) v\u00e0 t\u00e2m th\u1ea7n (lo l\u1eafng, c\u1ea3m x\u00fac thay \u0111\u1ed5i, \u00e1m \u1ea3nh\u2026). B\u1eaft \u0111\u1ea7u v\u1edbi thay \u0111\u1ed5i c\u1ea3m x\u00fac, h\u00e0nh vi k\u00e9o d\u00e0i 1-4 tu\u1ea7n, sau \u0111\u00f3 l\u00e0 m\u00faa v\u1eddn (4-18 th\u00e1ng) v\u00e0 ti\u1ebfp theo l\u00e0 y\u1ebfu v\u1eadn \u0111\u1ed9ng c\u1ee7a c\u01a1. Y\u1ebfu c\u01a1 v\u00e0 gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u00f3 th\u1ec3 k\u00e9o d\u00e0i trung b\u00ecnh 7 th\u00e1ng (17 th\u00e1ng) tr\u01b0\u1edbc khi h\u1ed3i ph\u1ee5c d\u1ea7n d\u1ea7n v\u00e0 kh\u00f4ng \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng.<\/span><\/p>\n

                    2.3\u00a0 Bi\u1ec3u hi\u1ec7n ph\u1ee5<\/strong><\/h3>\n

                    Tri\u1ec7u ch\u1ee9ng ph\u1ee5:<\/span><\/p>\n

                      \n
                    • \u00a0 \u00a0 \u00a0 <\/span>\u0110au kh\u1edbp nh\u01b0ng kh\u00f4ng vi\u00eam Kh\u00f4ng \u0111\u01b0\u1ee3c xem l\u00e0 ti\u00eau chu\u1ea9n ph\u1ee5 n\u1ebfu vi\u00eam kh\u1edbp \u0111\u00e3 \u0111\u01b0\u1ee3c t\u00ednh nh\u01b0 l\u00e0 ti\u00eau chu\u1ea9n ch\u00ednh trong ch\u1ea9n \u0111o\u00e1n.<\/span><\/li>\n
                    • \u00a0 \u00a0 \u00a0 <\/span>S\u1ed1t: th\u01b0\u1eddng > 38.8\u00a0 trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a th\u1ea5p m\u00e0 kh\u00f4ng \u0111i\u1ec1u tr\u1ecb.<\/span><\/li>\n
                    • \u00a0 \u00a0 \u00a0 <\/span>C\u1eadn l\u00e2m s\u00e0ng: CRP, t\u1ed1c \u0111\u1ed9 l\u1eafng m\u00e1u t\u0103ng.<\/span><\/li>\n
                    • \u00a0 \u00a0 \u00a0 <\/span>PR k\u00e9o d\u00e0i<\/span><\/li>\n
                    • \u00a0 \u00a0 \u00a0 <\/span>B\u1eb1ng ch\u1ee9ng c\u1ee7a nhi\u1ec5m li\u00ean c\u1ea7u nh\u00f3m A tr\u01b0\u1edbc \u0111\u00f3:<\/span><\/li>\n
                    • \u00a0 \u00a0 \u00a0 <\/span>B\u1ec7nh s\u1eed c\u1ee7a \u0111au h\u1ecdng hay s\u1ed1t tinh h\u1ed3ng nhi\u1ec7t \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m li\u00ean c\u1ea7u beta tan huy\u1ebft nh\u00f3m A.<\/span><\/li>\n
                    • \u00a0 \u00a0 \u00a0 <\/span>C\u1ea5y d\u1ecbch c\u1ed5 h\u1ecdng hay test kh\u00e1ng nguy\u00ean \u00edt c\u00f3 gi\u00e1 tr\u1ecb so v\u1edbi test kh\u00e1ng th\u1ec3 v\u00ec kh\u00f4ng ph\u00e2n bi\u1ec7t gi\u1eefa nhi\u1ec5m li\u00ean tr\u00f9ng g\u1ea7n \u0111\u00e2y hay l\u00e0 ng\u01b0\u1eddi l\u00e0nh mang tr\u00f9ng.<\/span><\/li>\n
                    • \u00a0 \u00a0 \u00a0 <\/span>Test kh\u00e1ng th\u1ec3 l\u00e0 c\u00f3 gi\u00e1 tr\u1ecb nh\u1ea5t. Kh\u1edfi ph\u00e1t c\u1ee7a bi\u1ec3u hi\u1ec7n th\u1ea5p tr\u00f9ng v\u1edbi \u0111\u1ec9nh c\u1ee7a n\u1ed3ng \u0111\u1ed9 kh\u00e1ng th\u1ec3. Antistreptolysin O (ASO) \u0111\u01b0\u1ee3c d\u00f9ng r\u1ed9ng r\u00e3i nh\u1ea5t. T\u0103ng trong 80% b\u1ec7nh nh\u00e2n th\u1ea5p v\u00e0 20% ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng. 67% b\u1ec7nh nh\u00e2n m\u00faa v\u1eddn c\u00f3 t\u0103ng ASO. Hi\u1ec7u gi\u00e1 > 333 \u0111\u01a1n v\u1ecb Todd \u1edf tr\u1ebb em v\u00e0 250 \u0111\u01a1n v\u1ecb Todd \u1edf ng\u01b0\u1eddi l\u1edbn\u00a0 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 t\u0103ng. ASO th\u1ea5p kh\u00f4ng lo\u1ea1i th\u1ea5p.<\/span><\/li>\n<\/ul>\n

                      2.4 Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n th\u1ea5p tim :<\/strong><\/h3>\n

                      Ch\u1ea9n \u0111o\u00e1n th\u1ea5p tim khi c\u00f3 :<\/span>
                      \n<\/span> – 2 ti\u00eau chu\u1ea9n ch\u00ednh v\u00e0 1 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m LCK ho\u1eb7c<\/span>
                      \n<\/span> – 1 ti\u00eau chu\u1ea9n ch\u00ednh, 2 ti\u00eau chu\u1ea9n ph\u1ee5 v\u00e0 1 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m LCK.<\/span><\/p>\n

                      3. Bi\u1ebfn ch\u1ee9ng b\u1ec7nh th\u1ea5p tim<\/strong><\/h2>\n

                      Di ch\u1ee9ng van tim th\u01b0\u1eddng g\u1eb7p c\u00e1c d\u1ea1ng sau:<\/span>
                      \n<\/span> – H\u1edf ho\u1eb7c h\u1eb9p van hai l\u00e1 , ho\u1eb7c d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng k\u1ebft h\u1ee3p.<\/span>
                      \n<\/span> – H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/span><\/p>\n

                      4.\u00a0 \u0110i\u1ec1u tr\u1ecb b\u1ec7nh th\u1ea5p tim<\/strong><\/h2>\n

                      4.1. Ch\u1ed1ng nhi\u1ec5m khu\u1ea9n :<\/strong><\/h3>\n

                      Penicillin G : 1 tri\u1ec7u \u0111\u01a1n v\u1ecb\/ng\u00e0y ti\u00eam b\u1eafp chia 2 l\u1ea7n trong 10 ng\u00e0y. Sau \u0111\u00f3 chuy\u1ec3n sang \u0111i\u1ec1u<\/span> tr\u1ecb d\u1ef1 ph\u00f2ng t\u00e1i ph\u00e1t (ph\u00f2ng th\u1ea5p c\u1ea5p II).<\/span>
                      \n<\/span> N\u1ebfu d\u1ecb \u1ee9ng v\u1edbi Penicillin th\u00ec d\u00f9ng Erythromycin 1g\/ng\u00e0y, u\u1ed1ng trong 10 ng\u00e0y r\u1ed3i chuy\u1ec3n<\/span> sang \u0111i\u1ec1u tr\u1ecb ph\u00f2ng th\u1ea5p c\u1ea5p II.<\/span><\/p>\n

                      4.2. Ch\u1ed1ng vi\u00eam :<\/strong><\/h3>\n

                      – <\/span>Th\u1ec3 vi\u00eam \u0111a kh\u1edbp \u0111\u01a1n thu\u1ea7n :<\/span>
                      \n<\/span> Aspirine : 100 mg\/kg\/ng\u00e0y x 7 ng\u00e0y. Sau \u0111\u00f3 gi\u1ea3m c\u00f2n 60 mg\/kg\/ng\u00e0y x 3 – 4 tu\u1ea7n.<\/span>
                      \n<\/span> Chia nh\u1ecf li\u1ec1u u\u1ed1ng c\u00e1ch 4 – 6 gi\u1edd\/l\u1ea7n. U\u1ed1ng c\u00f9ng v\u1edbi s\u1eefa ho\u1eb7c sau khi \u0103n \u0111\u1ec3 gi\u1ea3m s\u1ef1 k\u00edch<\/span> th\u00edch d\u1ea1 d\u00e0y.<\/span>
                      \n<\/span> – <\/span>Th\u1ec3 vi\u00eam tim :<\/span>
                      \n<\/span> Prednisolone : 2 mg\/kg\/ng\u00e0y x 2 – 3 tu\u1ea7n chia 2 – 3 l\u1ea7n u\u1ed1ng trong ng\u00e0y. T\u00f9y theo s\u1ef1 \u0111\u00e1p<\/span> \u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 d\u1ef1a v\u00e0o x\u00e9t nghi\u1ec7m(VS, CRP) sau \u0111\u00f3 gi\u1ea3m li\u1ec1u d\u1ea7n d\u1ea7n cho<\/span> h\u1ebft li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb (t\u1eeb 4 – 8 tu\u1ea7n). N\u00ean k\u1ebft h\u1ee3p v\u1edbi Aspirin v\u00e0o tu\u1ea7n cu\u1ed1i c\u1ee7a li\u1ec7u ph\u00e1p<\/span> corticoid \u0111\u1ec3 ng\u0103n ng\u1eeba t\u00e1i v\u01b0\u1ee3ng b\u1ec7nh, li\u1ec1u d\u00f9ng 60mg\/kg\/ng\u00e0y x 3-5 tu\u1ea7n.<\/span><\/p>\n

                      4.3. Ch\u1ebf \u0111\u1ed9 ngh\u1ec9 ng\u01a1i :<\/strong><\/h3>\n\n\n\n\n
                      L\u00e2m s\u00e0ng<\/span><\/td>\nNgh\u1ec9 tuy\u1ec7t \u0111\u1ed1i t\u1ea1i gi\u01b0\u1eddng<\/span><\/td>\n<\/tr>\n
                      Kh\u00f4ng vi\u00eam tim<\/span>
                      \n<\/span> Vi\u00eam tim, kh\u00f4ng suy tim.<\/span>
                      \n<\/span> C\u00f3 suy tim<\/span><\/td>\n                      		2 tu\u1ea7n.<\/span>
                      \n<\/span> 4 tu\u1ea7n.<\/span>
                      \n<\/span> T\u1ea5t c\u1ea3 th\u1eddi gian c\u00f2n suy tim.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                      \u00a0<\/span><\/p>\n

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

                        \n
                      1. <\/b> \u00a0 \u00a0 <\/span>ThS.BS. Nguy\u1ec5n Tr\u00ed H\u00e0o<\/b> \u2013 B\u1ec7nh Th\u1ea5p – <\/span>Khoa Tim m\u1ea1ch \u2013 B\u1ec7nh vi\u1ec7n Nhi \u0110\u1ed3ng 1.<\/b><\/li>\n
                      2. <\/b> \u00a0 \u00a0 <\/span>B\u1ec7nh Th\u1ea5p tim- B\u00e0i gi\u1ea3ng Nhi Khoa \u2013 \u0110\u1ea1i h\u1ecdc Y \u2013 d\u01b0\u1ee3c Hu\u1ebf<\/b><\/li>\n<\/ol>\n

                        \u00a0<\/span><\/p>\n

                        \u00a0<\/span><\/p>\n

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

                        Th\u1ea5p tim l\u00e0 b\u1ec7nh vi\u00eam lan t\u1ecfa c\u00e1c t\u1ed5 ch\u1ee9c li\u00ean k\u1ebft, c\u00e1c c\u01a1 quan th\u01b0\u1eddng b\u1ecb t\u1ed5n th\u01b0\u01a1ng l\u00e0 tim, kh\u1edbp, h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, da v\u00e0 t\u1ed5 ch\u1ee9c d\u01b0\u1edbi da. Trong \u0111\u00f3 t\u1ed5n th\u01b0\u01a1ng tim quan tr\u1ecdng nh\u1ea5t v\u00ec c\u00f3 th\u1ec3 \u0111\u01b0a \u0111\u1ebfn t\u1eed vong trong giai \u0111o\u1ea1n c\u1ea5p c\u1ee7a b\u1ec7nh ho\u1eb7c […]<\/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":"\nCh\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u1ea5p tim - Vinmec<\/title>\n<meta name=\"description\" content=\"Th\u1ea5p tim l\u00e0 b\u1ec7nh vi\u00eam lan t\u1ecfa c\u00e1c t\u1ed5 ch\u1ee9c li\u00ean k\u1ebft, c\u00e1c c\u01a1 quan th\u01b0\u1eddng b\u1ecb t\u1ed5n th\u01b0\u01a1ng l\u00e0 tim, kh\u1edbp, h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, da....\" \/>\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=\"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u1ea5p tim - 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