{"id":2619,"date":"2023-04-10T19:11:11","date_gmt":"2023-04-10T12:11:11","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2619"},"modified":"2023-04-17T16:37:29","modified_gmt":"2023-04-17T09:37:29","slug":"quan-ly-thuoc-truoc-phau-thuat-bac-cau-mach-vanh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/quan-ly-thuoc-truoc-phau-thuat-bac-cau-mach-vanh\/","title":{"rendered":"Qu\u1ea3n l\u00fd thu\u1ed1c tr\u01b0\u1edbc ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh"},"content":{"rendered":"

Qu\u1ea3n l\u00fd thu\u1ed1c tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt m\u1ea1ch v\u00e0nh l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng trong vi\u1ec7c \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt.\u00a0Vi\u1ec7c xem x\u00e9t v\u00e0 \u0111\u00e1nh gi\u00e1\u00a0 y\u1ebfu t\u1ed1 n\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 gi\u00fap \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 cho b\u1ec7nh nh\u00e2n trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt v\u00e0 ph\u1ee5c h\u1ed3i sau ph\u1eabu thu\u1eadt.<\/strong><\/p>\n

1.T\u1ea7m quan tr\u1ecdng c\u1ee7a chu\u1ea9n b\u1ecb tr\u01b0\u1edbc ph\u1eabu thu\u1eadt\u00a0<\/strong><\/h2>\n

Trong khi can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da(PCI) t\u1eadp trung \u0111\u1eb7c bi\u1ec7t v\u00e0o c\u00e1c v\u1ea5n \u0111\u1ec1 tim m\u1ea1ch c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi t\u00e1c \u0111\u1ed9ng t\u1ed1i thi\u1ec3u \u0111\u1ebfn c\u00e1c h\u1ec7 th\u1ed1ng c\u01a1 quan kh\u00e1c ngo\u1ea1i tr\u1eeb th\u1eadn th\u00ec ph\u1eabu thu\u1eadt tim h\u1edf c\u00f3 th\u1ec3 g\u00e2y ra m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5 \u0111\u00e1ng k\u1ec3, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c v\u1ea5n \u0111\u1ec1 b\u1ec7nh l\u00fd nh\u01b0 b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u00e3n t\u00ednh, ch\u1ee9c n\u0103ng gan ho\u1eb7c th\u1eadn k\u00e9m, b\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, v.v. Ch\u00fa \u00fd v\u00e0 qu\u1ea3n l\u00fd c\u1ea9n th\u1eadn c\u00e1c v\u1ea5n \u0111\u1ec1 n\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 t\u1ed1i \u01b0u h\u00f3a k\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt.<\/p>\n

2.Qu\u1ea3n l\u00fd s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng.<\/strong><\/h2>\n
    \n
  • Heparin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ng\u01b0ng s\u1eed d\u1ee5ng kho\u1ea3ng b\u1ed1n gi\u1edd tr\u01b0\u1edbc ph\u1eabu thu\u1eadt, tuy nhi\u00ean \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao , heparin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng \u0111\u1ebfn th\u1eddi \u0111i\u1ec3m ph\u1eabu thu\u1eadt. B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra l\u1ea1i s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u h\u00e0ng ng\u00e0y \u0111\u1ec3 ph\u00f2ng ng\u1eeba gi\u1ea3m ti\u1ec3u c\u1ea7u do heparin (HIT). L\u01b0u \u00fd r\u1eb1ng vi\u1ec7c \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt v\u1ec1 kh\u00e1ng th\u1ec3 HIT kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh n\u1ebfu kh\u00f4ng\u00a0 c\u00f3 g\u1ee3i \u00fd l\u00e2m s\u00e0ng.<\/li>\n
  • Heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p (LMWH) ph\u1ea3i ng\u01b0ng s\u1eed d\u1ee5ng \u00edt nh\u1ea5t 24 gi\u1edd tr\u01b0\u1edbc ph\u1eabu thu\u1eadt \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 ch\u1ea3y m\u00e1u sau ph\u1eabu thu\u1eadt. C\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng kh\u00f4ng ph\u1ea3i thu\u1ed1c \u1ee9c ch\u1ebf vitamin K (NOAC) (dabigatran, apixaban, rivaroxaban, edoxaban) n\u00ean \u0111\u01b0\u1ee3c ng\u01b0ng s\u1eed d\u1ee5ng \u00edt nh\u1ea5t 48 gi\u1edd tr\u01b0\u1edbc ph\u1eabu thu\u1eadt v\u00e0 c\u00f3 th\u1ec3 l\u00e2u h\u01a1n \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn k\u00e9m. Fondaparinux, \u0111\u00f4i khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch, th\u1eddi gian b\u00e1n h\u1ee7y c\u1ee7a thu\u1ed1c l\u00e0 17-21 gi\u1edd v\u00e0 ph\u1ea3i ng\u01b0ng s\u1eed d\u1ee5ng \u00edt nh\u1ea5t 60 gi\u1edd tr\u01b0\u1edbc ph\u1eabu thu\u1eadt.<\/li>\n
  • Aspirin th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ecbnh k\u1ef3 \u1edf b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u01b0\u1edbc \u0111\u00f3 ho\u1eb7c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng khi nh\u1eadp vi\u1ec7n. Aspirin 81mg n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng \u0111\u1ebfn th\u1eddi \u0111i\u1ec3m ph\u1eabu thu\u1eadt cho h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh (CABG), v\u00ec h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 m\u00e0 kh\u00f4ng c\u00f3 t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u \u0111\u00e1ng k\u1ec3.<\/li>\n
  • Vi\u1ec7c s\u1eed d\u1ee5ng ch\u1ea5t \u1ee9c ch\u1ebf P2Y12 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt trong v\u00e0i ng\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ec9 ra l\u00e0 t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u v\u00e0 ph\u1eabu thu\u1eadt l\u1ea1i do ch\u1ea3y m\u00e1u. Do \u0111\u00f3, \u0111\u00e3 \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb ng\u01b0ng s\u1eed d\u1ee5ng clopidogrel v\u00e0 ticagrelor trong 5 ng\u00e0y v\u00e0 prasugrel trong 7 ng\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt ch\u01b0\u01a1ng tr\u00ecnh. Ng\u01b0ng s\u1eed d\u1ee5ng thu\u1ed1c trong v\u00f2ng 3 ng\u00e0y c\u00f3 th\u1ec3 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c tr\u01b0\u1edbc ph\u1eabu thu\u1eadt c\u1ea5p c\u1ee9u. Ki\u1ec3m tra s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u h\u01a1n l\u00e0 th\u1eddi gian ng\u01b0ng s\u1eed d\u1ee5ng tr\u01b0\u1edbc ph\u1eabu thu\u1eadt, quy\u1ebft \u0111\u1ecbnh khi n\u00e0o ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u1edbi nguy c\u01a1 ch\u1ea3y m\u00e1u th\u1ea5p h\u01a1n.<\/li>\n
  • \u1ede b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1eabu thu\u1eadt v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1eb7t stent tr\u01b0\u1edbc \u0111\u00f3 <1 th\u00e1ng cho Stent kh\u00f4ng ph\u1ee7 thu\u1ed1c (BMS) v\u00e0 6-12 th\u00e1ng cho stent ph\u1ee7 thu\u1ed1c (DES), c\u00f3 nguy c\u01a1 t\u0103ng cao v\u1ec1 c\u1ee5c m\u00e1u trong stent n\u1ebfu \u1ee9c ch\u1ebf P2Y12 b\u1ecb ng\u01b0ng.X\u00e9t nghi\u1ec7m ph\u1ea3n \u1ee9ng P2Y12 (PRU) c\u00f3 th\u1ec3 ch\u1ec9 ra \u0111\u1ed9 nh\u1ea1y c\u1ea3m c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi thu\u1ed1c. T\u1ed1t nh\u1ea5t l\u00e0 tr\u00e1nh ph\u1eabu thu\u1eadt n\u1ebfu PRU cho th\u1ea5y \u1ee9c ch\u1ebf > 30%. Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 x\u00e9t nghi\u1ec7m n\u00e0y, ng\u01b0ng s\u1eed d\u1ee5ng thu\u1ed1c trong v\u00f2ng 3 ng\u00e0y c\u00f3 th\u1ec3 \u0111\u1ec3 l\u1ea1i m\u1ed9t s\u1ed1 ho\u1ea1t t\u00ednh ch\u1ed1ng ti\u1ec3u c\u1ea7u b\u1ea3o v\u1ec7 c\u00f2n l\u1ea1i v\u1edbi hy v\u1ecdng l\u00e0m gi\u1ea3m ch\u1ea3y m\u00e1u trong khi ph\u1eabu thu\u1eadt.<\/li>\n<\/ul>\n

    3.C\u00e1c lo\u1ea1i thu\u1ed1c tr\u01b0\u1edbc ph\u1eabu thu\u1eadt kh\u00e1c:<\/h2>\n
      \n
    • Amiodarone c\u00f3 l\u1ee3i trong vi\u1ec7c gi\u1ea3m t\u1ea7n su\u1ea5t xu\u1ea5t hi\u1ec7n rung nh\u0129 sau ph\u1eabu thu\u1eadt.<\/li>\n
    • Statin \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 gi\u1ea3m t\u1eed vong trong ph\u1eabu thu\u1eadt, c\u00e1c nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 v\u00e0 c\u00f3 th\u1ec3 gi\u1ea3m nguy c\u01a1 b\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p.<\/li>\n
    • Steroid \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u0111\u1ec3 gi\u1ea3m ph\u1ea3n \u1ee9ng vi\u00eam to\u00e0n c\u01a1 th\u1ec3 sau ph\u1eabu thu\u1eadt v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng c\u01a1 tim v\u00e0 c\u00f3 th\u1ec3 gi\u1ea3m t\u1ea7n su\u1ea5t xu\u1ea5t hi\u1ec7n rung nh\u0129. Tuy nhi\u00ean, vi\u1ec7c c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng ph\u1ed5i ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u00f5 r\u00e0ng v\u00e0 steroid l\u00e0m t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft sau ph\u1eabu thu\u1eadt. Steroid l\u00e0 m\u1ed9t ch\u1ee7 \u0111\u1ec1 tranh c\u00e3i, n\u00ean ch\u00fang ch\u01b0a \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i.<\/li>\n
    • Thi\u1ebfu m\u00e1u: Tr\u00ean th\u1ef1c t\u1ebf, \u0111\u00e3 c\u00f3 b\u00e1o c\u00e1o cho th\u1ea5y truy\u1ec1n m\u00e1u c\u00f3 t\u00e1c \u0111\u1ed9ng l\u1edbn h\u01a1n \u0111\u1ebfn t\u1eed vong.H\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n b\u1ecb thi\u1ebfu m\u00e1u do \u0111\u01b0\u1ee3c l\u1ea5y m\u00e1u li\u00ean t\u1ee5c \u0111\u1ec3 ki\u1ec3m tra m\u00e1u c\u0169ng nh\u01b0 m\u1ea5t m\u00e1u v\u00e0 m\u1ea5t n\u01b0\u1edbc trong qu\u00e1 tr\u00ecnh th\u1ef1c hi\u1ec7n. H\u01b0\u1edbng d\u1eabn khuy\u1ebfn ngh\u1ecb truy\u1ec1n m\u00e1u khi (Hb) <8 g\/dL \u1edf b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng nh\u1ed3i m\u00e1u c\u01a1 tim, m\u1ee9c Hb gi\u1eefa 8 v\u00e0 10 g\/dL \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o.<\/li>\n<\/ul>\n

      3 . K\u1ebft lu\u1eadn v\u1ec1 qu\u1ea3n l\u00fd thu\u1ed1c tr\u01b0\u1edbc ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh<\/strong><\/h2>\n

      Qu\u1ea3n l\u00fd thu\u1ed1c tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt m\u1ea1ch v\u00e0nh l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng trong vi\u1ec7c \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt. Vi\u1ec7c qu\u1ea3n l\u00fd \u0111\u00fang c\u00e1ch c\u00f3 th\u1ec3 gi\u1ea3m thi\u1ec3u r\u1ee7i ro ch\u1ea3y m\u00e1u v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt, \u0111\u1ed3ng th\u1eddi c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 ph\u1eabu thu\u1eadt v\u00e0 t\u0103ng kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i c\u1ee7a b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt. C\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u, thu\u1ed1c t\u0103ng huy\u1ebft \u00e1p, amiodarone, statins v\u00e0 steroid \u0111\u1ec1u c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong qu\u1ea3n l\u00fd thu\u1ed1c tr\u01b0\u1edbc ph\u1eabu thu\u1eadt m\u1ea1ch v\u00e0nh. Vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u00fang lo\u1ea1i thu\u1ed1c v\u00e0 qu\u1ea3n l\u00fd \u0111\u00fang c\u00e1ch l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt m\u1ea1ch v\u00e0nh.<\/p>\n

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

      Qu\u1ea3n l\u00fd thu\u1ed1c tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt m\u1ea1ch v\u00e0nh l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng trong vi\u1ec7c \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt.\u00a0Vi\u1ec7c xem x\u00e9t v\u00e0 \u0111\u00e1nh gi\u00e1\u00a0 y\u1ebfu t\u1ed1 n\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 gi\u00fap \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 cho b\u1ec7nh nh\u00e2n trong qu\u00e1 […]<\/p>\n","protected":false},"author":7,"featured_media":20119,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nQu\u1ea3n l\u00fd thu\u1ed1c tr\u01b0\u1edbc ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh - Vinmec<\/title>\n<meta name=\"description\" content=\"Qu\u1ea3n l\u00fd thu\u1ed1c tr\u01b0\u1edbc ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m nhi\u1ec1u, b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y s\u1ebd cung c\u1ea5p th\u00f4ng tin h\u1eefu \u00edch.\" \/>\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=\"Qu\u1ea3n l\u00fd thu\u1ed1c tr\u01b0\u1edbc ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u m\u1ea1ch v\u00e0nh - 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