{"id":25643,"date":"2023-04-20T19:39:48","date_gmt":"2023-04-20T12:39:48","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25643"},"modified":"2023-04-21T10:52:49","modified_gmt":"2023-04-21T03:52:49","slug":"theo-doi-tre-nguy-co-cao-cham-phat-trien-tam-than-van-dong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/20\/theo-doi-tre-nguy-co-cao-cham-phat-trien-tam-than-van-dong\/","title":{"rendered":"Theo d\u00f5i tr\u1ebb nguy c\u01a1 cao ch\u1eadm ph\u00e1t tri\u1ec3n t\u00e2m th\u1ea7n v\u1eadn \u0111\u1ed9ng\u00a0"},"content":{"rendered":"

Tr\u1ebb thu\u1ed9c nh\u00f3m nguy c\u01a1 cao ch\u1eadm ph\u00e1t tri\u1ec3n t\u00e2m th\u1ea7n v\u1eadn \u0111\u1ed9ng<\/a> l\u00e0 nh\u1eefng tr\u1ebb b\u1ecb c\u00e1c di ch\u1ee9ng do sinh non, nh\u1eb9 c\u00e2n, ch\u1eadm t\u0103ng tr\u01b0\u1edfng trong t\u1eed cung, d\u1ecb t\u1eadt b\u1ea9m sinh, thi\u1ebfu oxy n\u00e3o ho\u1eb7c c\u00e1c b\u1ec7nh l\u00fd n\u1eb7ng ph\u1ea3i \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c trong giai \u0111o\u1ea1n s\u01a1 sinh. C\u1ea7n c\u00f3 k\u1ebf ho\u1ea1ch theo d\u00f5i l\u00e2u d\u00e0i nh\u1eefng tr\u1ebb thu\u1ed9c nh\u00f3m nguy c\u01a1 cao nh\u1eb1m k\u1ecbp th\u1eddi ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c di ch\u1ee9ng, g\u1eedi c\u00e1c chuy\u00ean khoa t\u00e2m l\u00fd, th\u1ea7n kinh, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u… s\u1edbm, gi\u00fap tr\u1ebb nhanh ch\u00f3ng h\u00f2a nh\u1eadp c\u1ed9ng \u0111\u1ed3ng v\u00e0 x\u00e3 h\u1ed9i.\u00a0<\/strong><\/p>\n

1. Ch\u1ec9 \u0111\u1ecbnh theo d\u00f5i ch\u1eadm ph\u00e1t tri\u1ec3n t\u00e2m th\u1ea7n v\u1eadn \u0111\u1ed9ng<\/strong><\/h2>\n
    \n
  • Non th\u00e1ng \u2264 32 tu\u1ea7n tu\u1ed5i thai<\/li>\n
  • C\u00e2n n\u1eb7ng l\u00fac sinh \u2264 2.000g<\/li>\n
  • Nh\u1ecf so v\u1edbi tu\u1ed5i thai (SGA – small for gestational age)<\/li>\n
  • B\u1ec7nh l\u00fd n\u00e3o<\/li>\n
  • Suy h\u00f4 h\u1ea5p n\u1eb7ng ph\u1ea3i th\u1edf m\u00e1y<\/li>\n
  • V\u00e0ng da \u0111\u1ebfn ng\u01b0\u1ee1ng thay m\u00e1u R\u1ed1i lo\u1ea1n nhi\u1ec5m s\u1eafc th\u1ec3<\/li>\n<\/ul>\n

    2. L\u1ecbch theo d\u00f5i<\/h2>\n
      \n
    • 3 th\u00e1ng tu\u1ed5i<\/li>\n
    • 6 th\u00e1ng tu\u1ed5i<\/li>\n
    • 9 th\u00e1ng tu\u1ed5i<\/li>\n
    • 18 th\u00e1ng tu\u1ed5i<\/li>\n
    • 24 th\u00e1ng tu\u1ed5i<\/li>\n<\/ul>\n

      3. N\u1ed9i dung theo d\u00f5i ch\u1eadm ph\u00e1t tri\u1ec3n t\u00e2m th\u1ea7n v\u1eadn \u0111\u1ed9ng<\/strong><\/h2>\n

      3. 1 Theo d\u00f5i ph\u00e1t tri\u1ec3n th\u1ec3 ch\u1ea5t\u00a0<\/strong><\/p>\n

      – H\u01b0\u1edbng d\u1eabn cha m\u1eb9 tr\u1ebb c\u00e1ch theo d\u00f5i ph\u00e1t tri\u1ec3n th\u1ec3 ch\u1ea5t b\u1eb1ng bi\u1ec3u \u0111\u1ed3 t\u0103ng tr\u01b0\u1edfng chi\u1ec1u<\/p>\n

      cao v\u00e0 c\u00e2n n\u1eb7ng trong s\u1ed5 s\u1ee9c kho\u1ebb b\u00e0 m\u1eb9 v\u00e0 tr\u1ebb em ho\u1eb7c bi\u1ec3u \u0111\u1ed3 Fenton n\u1ebfu tr\u1ebb sinh non.<\/p>\n

      –\u00a0V\u1ebd bi\u1ec3u \u0111\u1ed3 t\u0103ng tr\u01b0\u1edfng chi\u1ec1u cao, c\u00e2n n\u1eb7ng v\u00e0 v\u00f2ng \u0111\u1ea7u m\u1ed7i l\u1ea7n t\u00e1i kh\u00e1m theo l\u1ecbch.<\/p>\n

      3.2 T\u1ea7m so\u00e1t khi\u1ebfm khuy\u1ebft\u00a0<\/strong><\/p>\n

      –\u00a0 Kh\u00e1m t\u1ea7m so\u00e1t b\u1ec7nh l\u00fd v\u00f5ng m\u1ea1c tr\u1ebb sinh non n\u1ebfu:<\/p>\n

      + C\u00e2n n\u1eb7ng l\u00fac sinh \u2264 1.750g ho\u1eb7c tu\u1ed5i thai khi sinh \u2264 33 tu\u1ea7n.<\/p>\n

      + C\u00e2n n\u1eb7ng l\u00fac sinh \u2264 2.000g k\u00e8m ti\u1ec1n s\u1eed sau sinh c\u00f3 b\u1ea5t k\u1ef3 m\u1ed9t trong nh\u1eefng y\u1ebfu t\u1ed1 sau:<\/p>\n

      th\u1edf oxy, th\u1edf CPAP, th\u1edf m\u00e1y, thi\u1ebfu m\u00e1u, sinh \u0111\u00f4i.<\/p>\n

      Kh\u00e1m t\u1ea7m so\u00e1t khi\u1ebfm th\u00ednh khi tr\u1ebb \u0111\u01b0\u1ee3c 40 tu\u1ea7n tu\u1ed5i \u0111i\u1ec1u ch\u1ec9nh.<\/p>\n

      Si\u00eau \u00e2m xuy\u00ean th\u00f3p v\u00e0 si\u00eau \u00e2m tim Doppler khi tr\u1ebb \u0111\u01b0\u1ee3c 40 tu\u1ea7n tu\u1ed5i \u0111i\u1ec1u ch\u1ec9nh n\u1ebfu tr\u1ebb non th\u00e1ng.<\/p>\n

      –\u00a0Si\u00eau \u00e2m xuy\u00ean th\u00f3p 1 th\u00e1ng sau khi xu\u1ea5t vi\u1ec7n n\u1ebfu tr\u1ebb \u0111\u1ee7 th\u00e1ng.<\/p>\n

      X\u00e9t nghi\u1ec7m t\u1ea7m so\u00e1t thi\u1ebfu men G6PD, suy gi\u00e1p b\u1ea9m sinh, t\u0103ng sinh tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn<\/p>\n

      b\u1ea9m sinh v\u00e0o l\u1ea7n t\u00e1i kh\u00e1m \u0111\u1ea7u ti\u00ean n\u1ebfu tr\u1ebb ch\u01b0a \u0111\u01b0\u1ee3c l\u00e0m.<\/p>\n

      3.3 S\u00e0ng l\u1ecdc b\u1ea5t th\u01b0\u1eddng ph\u00e1t tri\u1ec3n t\u00e2m th\u1ea7n v\u1eadn \u0111\u1ed9ng\u00a0<\/strong><\/p>\n

      – Cha m\u1eb9 s\u1ebd t\u1ef1 \u0111\u00e1nh gi\u00e1 c\u00e1c d\u1ea5u hi\u1ec7u nguy c\u01a1 d\u1ef1a v\u00e0o s\u1ed5 s\u1ee9c kho\u1ebb b\u00e0 m\u1eb9 v\u00e0 tr\u1ebb em, ph\u00e2n d\u00e0nh cho gia \u0111\u00ecnh ghi.<\/p>\n

      – N\u1eef h\u1ed9 sinh\/\u0110i\u1ec1u d\u01b0\u1ee1ng nh\u1eadn b\u1ec7nh s\u1ebd \u0111\u00e1nh gi\u00e1 l\u1ea1i c\u00e1c d\u1ea5u hi\u1ec7u nguy c\u01a1 d\u1ef1a v\u00e0o s\u1ed5 s\u1ee9c kho\u1ebb b\u00e0 m\u1eb9 v\u00e0 tr\u1ebb em, ph\u1ea7n d\u00e0nh cho nh\u00e2n vi\u00ean y t\u1ebf ghi.<\/p>\n

      3.4 Kh\u00e1m \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u\u00a0<\/strong><\/p>\n

      N\u1ebfu tr\u1ebb c\u00f3 d\u1ea5u hi\u1ec7u nguy c\u01a1, b\u00e1c s\u0129 s\u01a1 sinh s\u1ebd kh\u00e1m \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u.<\/p>\n

      3.5 H\u1ed9i ch\u1ea9n v\u1edbi chuy\u00ean khoa\u00a0<\/strong><\/p>\n

      N\u1ebfu kh\u00e1m \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u ph\u00e1t hi\u1ec7n b\u1ea5t th\u01b0\u1eddng, b\u00e1c s\u0129 s\u01a1 sinh s\u1ebd ch\u1ec9 \u0111\u1ecbnh h\u1ed9i ch\u1ea9n v\u1edbi b\u00e1c s\u0129 khoa V\u1eadt l\u00fd tr\u1ecb li\u1ec7u ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng.<\/p>\n

      C\u00f3 th\u1ec3 ph\u1ea3i ch\u1ec9 \u0111\u1ecbnh th\u00eam c\u00e1c x\u00e9t nghi\u1ec7m chuy\u00ean s\u00e2u nh\u01b0 nhi\u1ec5m s\u1eafc th\u1ec3 \u0111\u1ed3, CT scan, MRI, \u0111i\u1ec7n n\u00e3o \u0111\u1ed3.<\/p>\n

      3.6 Gi\u1edbi thi\u1ec7u kh\u00e1m chuy\u00ean khoa\u00a0<\/strong><\/p>\n

      N\u1ebfu ph\u00e1t hi\u1ec7n b\u1ec7nh l\u00fd hay b\u1ea5t th\u01b0\u1eddng b\u1ea9m sinh.<\/p>\n

      4. H\u01b0\u1edbng d\u1eabn kh\u00e1m v\u00e0 \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u<\/strong><\/h2>\n

      4.1 C\u00e1c bi\u1ec3u hi\u1ec7n b\u00ecnh th\u01b0\u1eddng c\u1ee7a ph\u00e1t tri\u1ec3n v\u1eadn \u0111\u1ed9ng, ng\u00f4n ng\u1eef nh\u1eadn th\u1ee9c, c\u1ea3m x\u00fac x\u00e3 h\u1ed9i\u00a0<\/strong><\/p>\n

      * L\u00fac 3 th\u00e1ng\u00a0<\/strong><\/p>\n

      – Bi\u1ebft l\u1eadt ng\u01b0\u1eddi t\u1eeb ng\u1eeda th\u00e0nh \u00fap<\/p>\n

      C\u00f3 k\u1ef9 n\u0103ng n\u1eafm, ch\u1ee5p, c\u00f3 ph\u1ea3n x\u1ea1 t\u1ed1t v\u1edbi \u0111\u00f4i b\u00e0n tay<\/p>\n

      – Bi\u1ebft c\u00e1ch ch\u01a1i v\u1edbi \u0111\u1ed3 ch\u01a1i nh\u01b0 rung l\u1eafc \u0111\u1ec3 t\u1ea1o \u00e2m thanh<\/p>\n

      G\u1eeb g\u1eeb v\u00e0 r\u00edu r\u00edt m\u1ed9t c\u00e1ch vui v\u1ebb khi \u0111\u01b0\u1ee3c ch\u00fa \u00fd<\/p>\n

      – M\u1ec9m c\u01b0\u1eddi v\u1edbi ng\u01b0\u1eddi \u0111\u1ed1i di\u1ec7n<\/p>\n

      * 6 th\u00e1ng\u00a0<\/strong><\/p>\n

      C\u00f3 th\u1ec3 ng\u1ed3i v\u00e0 quan s\u00e1t xung quanh<\/p>\n

      C\u00f3 th\u1ec3 l\u1eadt theo hai h\u01b0\u1edbng v\u00e0 tr\u01b0\u1eddn<\/p>\n

      V\u1edbi l\u1ea5y v\u00e0 bu\u00f4ng tay th\u1ea3 c\u00e1c \u0111\u1ed3 v\u1eadt ra, ph\u1ed1i h\u1ee3p 2 tay<\/p>\n

      C\u01b0\u1eddi v\u00e0 c\u01b0\u1eddi r\u00e9 l\u00ean khi vui<\/p>\n

      Nh\u1eadn bi\u1ebft c\u00e1c khu\u00f4n m\u1eb7t v\u00e0 t\u1ecf ra th\u00edch ng\u01b0\u1eddi quen<\/p>\n

      B\u1eadp b\u1eb9 n\u00f3i chuy\u1ec7n b\u1eb1ng nh\u1eefng \u00e2m thanh<\/p>\n

      Th\u00edch giao ti\u1ebfp x\u00e3 h\u1ed9i, bi\u1ebft \u00f4m b\u1ed1 m\u1eb9 v\u00e0 nh\u1eefng ng\u01b0\u1eddi th\u00e2n<\/p>\n

      * 9 th\u00e1ng\u00a0<\/strong><\/p>\n

      T\u1ef1 ng\u1ed3i, tr\u01b0\u1eddn, b\u00f2<\/p>\n

      Kh\u00e9o l\u00e9o ph\u1ed1i h\u1ee3p 2 tay, s\u1eed d\u1ee5ng ng\u00f3n c\u00e1i v\u00e0 tr\u1ecf<\/p>\n

      Ph\u00e1t \u0111\u01a1n \u00e2m<\/p>\n

      Bi\u1ebft b\u1eaft ch\u01b0\u1edbc, ch\u01a1i \u00fa \u00f2a<\/p>\n

      * 12 th\u00e1ng\u00a0<\/strong><\/p>\n

      – V\u1ecbn \u0111\u1ee9ng, c\u00f3 th\u1ec3 t\u1ef1 \u0111\u1ee9ng, \u0111i v\u00e0i b\u01b0\u1edbc C\u00f3 th\u1ec3 b\u1ecf b\u1ecb v\u00e0o ly<\/p>\n

      – C\u00f3 th\u1ec3 ph\u00e1t \u0111\u01b0\u1ee3c 2 \u00e2m<\/p>\n

      – Hi\u1ec3u m\u1ed9t s\u1ed1 m\u1ec7nh l\u1ec7nh, nh\u1eadn bi\u1ebft t\u00ean m\u00ecnh<\/p>\n

      * 18 th\u00e1ng\u00a0<\/strong><\/p>\n

      – \u0110i nhanh v\u1eefng, c\u00f3 th\u1ec3 leo c\u1ea7u thang<\/p>\n

      – C\u00f3 th\u1ec3 l\u1ea5y b\u1ecb trong ly ra<\/p>\n

      – T\u1ef1 \u0103n b\u1eb1ng mu\u1ed7ng<\/p>\n

      . Ph\u00e1t \u0111\u01b0\u1ee3c 2 \u00e2m<\/p>\n

      Th\u00edch ch\u01a1i v\u1edbi b\u1ea1n b\u00e8<\/p>\n

      * 24 th\u00e1ng\u00a0<\/strong><\/p>\n

      – C\u00f3 th\u1ec3 l\u00ean c\u1ea7u thang<\/p>\n

      – V\u1ebd \u0111\u01b0\u1eddng th\u1eb3ng, \u0111\u01b0\u1eddng v\u00f2ng tr\u00f2n<\/p>\n

      – C\u00f3 th\u1ec3 n\u00f3i th\u00e0nh c\u00e2u, c\u00f3 th\u1ec3 h\u1ecdc h\u00e1t<\/p>\n

      –\u00a0 C\u00f3 th\u1ec3 m\u1eb7c \u00e1o qu\u1ea7n, r\u1eeda tay<\/p>\n

      4.2 C\u00e1c bi\u1ec3u hi\u1ec7n b\u1ea5t th\u01b0\u1eddng c\u1ee7a ph\u00e1t tri\u1ec3n v\u1eadn \u0111\u1ed9ng, ng\u00f4n ng\u1eef nh\u1eadn th\u1ee9c, giao ti\u1ebfp\u00a0 <\/strong>x\u00e3 h\u1ed9i\u00a0<\/strong><\/p>\n

      * V\u1ec1 v\u1eadn \u0111\u1ed9ng th\u00f4:\u00a0<\/strong><\/p>\n

      – \u0110\u1ebfn 7 th\u00e1ng tu\u1ed5i v\u1eabn kh\u00f4ng l\u1eadt \u0111\u01b0\u1ee3c<\/p>\n

      – \u0110\u1ebfn 10 th\u00e1ng tu\u1ed5i kh\u00f4ng ng\u1ed3i \u0111\u01b0\u1ee3c m\u1ed9t m\u00ecnh<\/p>\n

      – \u0110\u1ebfn 12 th\u00e1ng tu\u1ed5i kh\u00f4ng \u0111\u1ee9ng l\u00ean \u0111\u01b0\u1ee3c<\/p>\n

      – \u0110\u1ebfn 14 th\u00e1ng tu\u1ed5i kh\u00f4ng \u0111\u1ee9ng ch\u1ef1ng \u0111\u01b0\u1ee3c<\/p>\n

      – \u0110\u1ebfn 18 th\u00e1ng tu\u1ed5i kh\u00f4ng \u0111i \u0111\u01b0\u1ee3c<\/p>\n

      * V\u1ec1 v\u1eadn \u0111\u1ed9ng tinh t\u1ebf:\u00a0<\/strong><\/p>\n

      – \u0110\u1ebfn 6 th\u00e1ng tu\u1ed5i v\u1eabn th\u01b0\u1eddng xuy\u00ean n\u1eafm ch\u1eb7t 2 b\u00e0n tay<\/p>\n

      – \u0110\u1ebfn 10 th\u00e1ng tu\u1ed5i kh\u00f4ng bi\u1ebft \u0111\u01b0a hai tay ra tr\u01b0\u1edbc m\u1eb7t<\/p>\n

      – \u0110\u1ebfn 12 th\u00e1ng tu\u1ed5i kh\u00f4ng bi\u1ebft v\u1ed7 tay<\/p>\n

      – Ch\u1ec9 d\u00f9ng c\u00f3 m\u1ed9t tay<\/p>\n

      * V\u1ec1 nh\u1eadn th\u1ee9c:\u00a0<\/strong><\/p>\n

      – \u0110\u1ebfn 8 th\u00e1ng tu\u1ed5i kh\u00f4ng bi\u1ebft ph\u00e2n bi\u1ec7t l\u1ea1 quen<\/p>\n

      – \u0110\u1ebfn 15 th\u00e1ng tu\u1ed5i kh\u00f4ng bi\u1ebft ch\u01a1i \u201cgi\u1ea3 v\u1edd\u201d v\u1edbi b\u00fap b\u00ea (nh\u01b0 \u0111\u00fat cho b\u00fap b\u00ea \u0103n, h\u00f4n b\u00fap\u00a0b\u00ea)<\/p>\n

      * V\u1ec1 giao ti\u1ebfp x\u00e3 h\u1ed9i:\u00a0<\/strong><\/p>\n

      Th\u01b0\u1eddng l\u0103ng x\u0103ng, k\u00e9m t\u1eadp trung<\/p>\n

      –\u00a0 K\u00e9n \u0103n<\/p>\n

      – S\u1ee3 t\u1eafm, s\u1ee3 \u0111\u00e1nh r\u0103ng, s\u1ee3 c\u1eaft t\u00f3c<\/p>\n

      –\u00a0 D\u01b0\u1eddng nh\u01b0 kh\u00f4ng nghe khi \u0111\u01b0\u1ee3c k\u00eau t\u00ean<\/p>\n

      4.3 C\u00e1c d\u1ea5u hi\u1ec7u ph\u00e1t hi\u1ec7n s\u1edbm b\u1ea1i n\u00e3o l\u00fac 6 th\u00e1ng tu\u1ed5i\u00a0<\/strong><\/p>\n

      * B\u1ed1n d\u1ea5u hi\u1ec7u ch\u00ednh:<\/p>\n

      –\u00a0Kh\u00f4ng l\u1eadt, kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u1ea7u c\u1ed5<\/p>\n

      –\u00a0G\u1ed3ng, ch\u00e2n du\u1ed7i c\u1ee9ng khi \u0111\u1eb7t \u0111\u1ee9ng<\/p>\n

      – Hai tay n\u1eafm ch\u1eb7t<\/p>\n

      – Hai tay kh\u00f4ng bi\u1ebft v\u1edbi, c\u1ea7m<\/p>\n

      * B\u1ed1n d\u1ea5u hi\u1ec7u ph\u1ee5:<\/p>\n

      – Kh\u00f4ng nh\u1eadn ra m\u1eb9<\/p>\n

      – \u00a0\u0102n, u\u1ed1ng kh\u00f3 kh\u0103n<\/p>\n

      – Kh\u00f4ng \u0111\u00e1p \u1ee9ng khi g\u1ecdi h\u1ecfi<\/p>\n

      –\u00a0Kh\u00f3c nhi\u1ec1u su\u1ed1t ng\u00e0y \u0111\u00eam<\/p>\n

      \"minh-hoa-cham-phat-trien-tam-than-van-dong\"<\/p>\n

        \n
      1. B\u1ed9 Y T\u1ebf – C\u1ee5c qu\u1ea3n l\u00fd kh\u00e1m, ch\u1eefa b\u1ec7nh (2011), H\u01b0\u1edbng d\u1eabn Ph\u00e1t hi\u1ec7n s\u1edbm – Can thi\u1ec7p s\u1edbm tr\u1ebb em khuy\u1ebft t\u1eadt.<\/li>\n
      2. Quy\u1ebft \u0111\u1ecbnh s\u1ed1 65\/Q\u0110-BVTD ng\u00e0y 19\/4 \/2019 c\u1ee7a b\u1ec7nh vi\u1ec7n T\u1eeb D\u0169.<\/li>\n<\/ol>\n

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

        Tr\u1ebb thu\u1ed9c nh\u00f3m nguy c\u01a1 cao ch\u1eadm ph\u00e1t tri\u1ec3n t\u00e2m th\u1ea7n v\u1eadn \u0111\u1ed9ng l\u00e0 nh\u1eefng tr\u1ebb b\u1ecb c\u00e1c di ch\u1ee9ng do sinh non, nh\u1eb9 c\u00e2n, ch\u1eadm t\u0103ng tr\u01b0\u1edfng trong t\u1eed cung, d\u1ecb t\u1eadt b\u1ea9m sinh, thi\u1ebfu oxy n\u00e3o ho\u1eb7c c\u00e1c b\u1ec7nh l\u00fd n\u1eb7ng ph\u1ea3i \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c trong giai \u0111o\u1ea1n s\u01a1 sinh. 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