{"id":2674,"date":"2023-04-10T18:54:21","date_gmt":"2023-04-10T11:54:21","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2674"},"modified":"2023-04-19T15:02:22","modified_gmt":"2023-04-19T08:02:22","slug":"cham-soc-sau-phau-thuat-tim-ho-tai-don-vi-hoi-suc-tich-cuc","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/cham-soc-sau-phau-thuat-tim-ho-tai-don-vi-hoi-suc-tich-cuc\/","title":{"rendered":"Ch\u0103m s\u00f3c sau ph\u1eabu thu\u1eadt tim h\u1edf t\u1ea1i \u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c t\u00edch c\u1ef1c"},"content":{"rendered":"<p><strong>Ch\u0103m s\u00f3c sau ph\u1eabu thu\u1eadt quan tr\u1ecdng\u00a0 khi ca ph\u1eabu thu\u1eadt k\u1ebft th\u00fac.\u00a0 C\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111\u01b0\u1eddng th\u1edf v\u00e0 th\u00f4ng kh\u00ed, h\u1ea1 huy\u1ebft \u00e1p ho\u1eb7c t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9t ng\u1ed9t, lo\u1ea1n nh\u1ecbp tim, ch\u1ea3y m\u00e1u trung th\u1ea5t t\u0103ng, thay \u0111\u1ed5i thu\u1ed1c v\u00e0 v\u1ea5n \u0111\u1ec1 v\u1ec1 \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n c\u00f3 th\u1ec3 x\u1ea3y ra.<\/strong><\/p>\n<h2><strong>1.Nh\u1eadp vi\u1ec7n v\u00e0o \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c t\u00edch c\u1ef1c (ICU)<\/strong><\/h2>\n<p>Giai \u0111o\u1ea1n ch\u0103m s\u00f3c sau ph\u1eabu thu\u1eadt quan tr\u1ecdng \u0111\u1ea7u ti\u00ean b\u1eaft \u0111\u1ea7u khi ca ph\u1eabu thu\u1eadt k\u1ebft th\u00fac. Trong qu\u00e1 tr\u00ecnh chuy\u1ec3n t\u1eeb b\u00e0n ph\u1eabu thu\u1eadt sang gi\u01b0\u1eddng ICU, t\u1eeb h\u1ec7 th\u1ed1ng gi\u00e1m s\u00e1t n\u00e0y sang h\u1ec7 th\u1ed1ng kh\u00e1c v\u00e0 t\u1eeb ph\u00f2ng m\u1ed5 \u0111\u1ebfn ICU, c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111\u01b0\u1eddng th\u1edf v\u00e0 th\u00f4ng kh\u00ed, h\u1ea1 huy\u1ebft \u00e1p ho\u1eb7c t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9t ng\u1ed9t, lo\u1ea1n nh\u1ecbp tim, ch\u1ea3y m\u00e1u trung th\u1ea5t t\u0103ng, thay \u0111\u1ed5i thu\u1ed1c v\u00e0 v\u1ea5n \u0111\u1ec1 v\u1ec1 \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n c\u00f3 th\u1ec3 x\u1ea3y ra.<\/p>\n<h2><strong>2.C\u00e1c v\u1ea5n \u0111\u1ec1 theo d\u00f5i t\u1ea1i \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c t\u00edch c\u1ef1c(ICU)<\/strong><\/h2>\n<ul>\n<li>\u0110i\u1ec7n t\u00e2m \u0111\u1ed3 (ECG), huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch x\u00e2m l\u1ea5n v\u00e0 b\u00e3o h\u00f2a oxy trong m\u00e1u (SpO2) \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ed5i tr\u00ean m\u00e0n h\u00ecnh tr\u01b0\u1edbc khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c chuy\u1ec3n sang gi\u01b0\u1eddng ICU. Trong qu\u00e1 tr\u00ecnh chuy\u1ec3n, B\u00e1c s\u0129 g\u00e2y m\u00ea ph\u1ea3i ph\u1ed1i h\u1ee3p trong qu\u00e1 tr\u00ecnh chuy\u1ec3n b\u1ec7nh t\u1eeb khu ph\u00f2ng m\u1ed5 \u0111\u1ebfn khu h\u1ed3i s\u1ee9c, \u0111\u1eb7c bi\u1ec7t ch\u00fa \u00fd \u0111\u1ebfn \u0111\u01b0\u1eddng th\u1edf v\u1edbi th\u1edf b\u1eb1ng b\u00f3ng Ambu k\u1ebft n\u1ed1i v\u1edbi b\u00ecnh kh\u00ed oxy . Ph\u1ea3i ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c \u0111\u01b0\u1eddng x\u00e2m nh\u1eadp tr\u00ean c\u01a1 th\u1ec3, d\u00e2y \u0111i\u1ec7n nh\u1ecbp tim, \u1ed1ng ti\u1ec3u v\u00e0 \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o kh\u00f4ng g\u00ec b\u1ecb m\u1ea5t v\u1ecb tr\u00ed trong qu\u00e1 tr\u00ecnh di chuy\u1ec3n.<\/li>\n<li>C\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c \u0111\u1eb7t tr\u00ean m\u00e1y b\u01a1m ti\u00eam \u0111i\u1ec7n \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o t\u1ed1c \u0111\u1ed9 ti\u00eam ch\u00ednh x\u00e1c. Nh\u1eefng m\u00e1y b\u01a1m ti\u00eam n\u00e0y \u0111\u01b0\u1ee3c c\u1eafm v\u00e0o trong su\u1ed1t th\u1eddi gian ph\u1eabu thu\u1eadt. L\u1ef1a ch\u1ecdn m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c tim m\u1ea1ch lu\u00f4n ph\u1ea3i c\u00f3 s\u1eb5n trong tr\u01b0\u1eddng h\u1ee3p kh\u1ea9n c\u1ea5p trong qu\u00e1 tr\u00ecnh chuy\u1ec3n.<\/li>\n<li>Khi \u0111\u1ebfn ICU, \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n \u0111\u01b0\u1ee3c k\u1ebft n\u1ed1i v\u1edbi m\u00e1y th\u1edf v\u00e0 ECG, d\u00f2ng \u00e1p \u0111\u1ed9ng m\u1ea1ch v\u00e0 \u0111o b\u00e3o h\u00f2a oxy trong m\u00e1u \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ed5i tr\u00ean m\u00e0n h\u00ecnh gi\u01b0\u1eddng b\u1ec7nh. T\u1ed1c \u0111\u1ed9 truy\u1ec1n thu\u1ed1c \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh tr\u00ean m\u00e1y b\u01a1m ti\u00eam t\u1ef1 \u0111\u1ed9ng, \u01b0u ti\u00ean s\u1eed d\u1ee5ng nh\u1eefng m\u00e1y b\u01a1m ti\u00eam \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong ph\u00f2ng m\u1ed5 \u0111\u1ec3 tr\u00e1nh t\u1ea1m th\u1eddi ng\u1eebng truy\u1ec1n thu\u1ed1c cho b\u1ec7nh nh\u00e2n. H\u1ec7 th\u1ed1ng \u1ed1ng d\u1eabn l\u01b0u trong ng\u1ef1c \u0111\u01b0\u1ee3c k\u1ebft n\u1ed1i v\u1edbi m\u00e1y h\u00fat li\u00ean t\u1ee5c.<\/li>\n<\/ul>\n<h2><strong>3. Kh\u00e1m b\u1ec7nh nh\u00e2n t\u1ea1i \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c<\/strong><\/h2>\n<h3><strong>3.1 Th\u00f4ng kh\u00ed: <\/strong><\/h3>\n<p>B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u00f4ng kh\u00ed t\u1ed1t b\u1eb1ng c\u00e1ch quan s\u00e1t di \u0111\u1ed9ng ng\u1ef1c, nghe th\u00f4ng kh\u00ed hai b\u00ean ph\u1ed5i v\u00e0 \u0111o \u0111\u1ed9 b\u00e3o h\u00f2a oxy SpO2( th\u01b0\u1eddng tr\u00ean 90%).<\/p>\n<h3>3.2 Tr\u00ean mornitor<\/h3>\n<p>Tr\u00ean m\u00e0n h\u00ecnh mornitor v\u00e0 sau \u0111\u00f3 l\u00e0 tr\u00ean gi\u01b0\u1eddng b\u1ec7nh, ph\u00e2n t\u00edch ECG cho th\u1ea5y nh\u1ecbp tim \u0111\u1ec1u \u0111\u1eb7n.<\/p>\n<p><strong>3.3 Huy\u1ebft \u00e1p tr\u00ean mornitor:<\/strong><\/p>\n<p>\u0110\u00e1nh gi\u00e1 ngay v\u1edbi\u00a0 c\u00e1c b\u1ea5t th\u01b0\u1eddng n\u00e0o \u0111\u01b0\u1ee3c nghi ng\u1edd khi nh\u1eadp v\u00e0o khoa ICU, cho d\u00f9 th\u1ef1c s\u1ef1 hay gi\u1ea3 \u0111\u1ec1u l\u00e0 c\u1ea7n thi\u1ebft. Hai v\u1ea5n \u0111\u1ec1 ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u1eb7p ph\u1ea3i l\u00e0 huy\u1ebft \u00e1p th\u1ea5p v\u00e0 ECG kh\u00f4ng r\u00f5.<\/p>\n<p>+ <em>Huy\u1ebft \u00e1p th\u1ea5p<\/em> (huy\u1ebft \u00e1p t\u00e2m thu &lt;90 mm Hg ho\u1eb7c huy\u1ebft \u00e1p trung b\u00ecnh &lt;60 mm Hg) th\u01b0\u1eddng g\u00e2y ra b\u1edfi t\u00ecnh tr\u1ea1ng thi\u1ebfu n\u01b0\u1edbc\u00a0 ho\u1eb7c ng\u1eebng \u0111\u1ed9t ng\u1ed9t dung d\u1ecbch truy\u1ec1n t\u0129nh m\u1ea1ch. Tuy nhi\u00ean, lu\u00f4n c\u1ea7n l\u01b0u \u00fd \u0111\u1ebfn kh\u1ea3 n\u0103ng c\u00f3 v\u1ea5n \u0111\u1ec1 nghi\u00eam tr\u1ecdng h\u01a1n, ch\u1eb3ng h\u1ea1n nh\u01b0 m\u1ea5t m\u00e1u c\u1ea5p, suy tim c\u1ea5p, r\u1ed1i lo\u1ea1n nh\u1ecbp tim ho\u1eb7c v\u1ea5n \u0111\u1ec1 h\u00f4 h\u1ea5p. Huy\u1ebft \u00e1p th\u1ea5p c\u0169ng c\u00f3 th\u1ec3 do vi\u1ec7c kh\u00f4ng hi\u1ec7u ch\u1ec9nh tranducer ho\u1eb7c do u\u1ed1n cong ho\u1eb7c t\u1eafc ngh\u1ebdn t\u1ea1m th\u1eddi c\u1ee7a \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch. N\u1ebfu huy\u1ebft \u00e1p \u0111o th\u1ea5p, l\u00e0m theo c\u00e1c b\u01b0\u1edbc sau \u0111\u00e2y:<\/p>\n<ul>\n<li>Ti\u1ebfp t\u1ee5c th\u00f4ng kh\u00ed v\u00e0 nghe \u00e2m thanh h\u00f4 h\u1ea5p hai b\u00ean ph\u1ed5i.<\/li>\n<li>X\u00e1c \u0111\u1ecbnh m\u1ea1ch v\u00e0 huy\u1ebft \u00e1p\u00a0 b\u1eb1ng c\u00e1ch s\u1edd m\u1ea1ch tay ho\u1eb7c \u0111\u00f9i. G\u1eafn b\u0103ng \u0111o huy\u1ebft \u00e1p tr\u00ean \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch v\u00e0 th\u1ef1c hi\u1ec7n \u0111o huy\u1ebft \u00e1p b\u1eb1ng tay.<\/li>\n<li>\u0110\u1ea3m b\u1ea3o r\u1eb1ng t\u1ea5t c\u1ea3 c\u00e1c chai thu\u1ed1c \u0111\u01b0\u1ee3c \u0111\u00e1nh d\u1ea5u \u0111\u00fang v\u00e0 \u0111\u01b0\u1ee3c truy\u1ec1n cho\u00a0 b\u1ec7nh nh\u00e2n v\u00e0 truy\u1ec1n v\u00e0o t\u1ed1c \u0111\u1ed9 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh th\u00f4ng qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (IV)<\/li>\n<\/ul>\n<p>Ch\u00fa \u00fd: N\u1ebfu huy\u1ebft \u00e1p th\u1ea5p, x\u00e1c \u0111\u1ecbnh xem b\u1ec7nh nh\u00e2n c\u00f3 \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nitroglycerin ho\u1eb7c nitroprusside.<\/p>\n<p><em>+ \u0110i\u1ec7n t\u00e2m \u0111\u1ed3:<\/em> Xem x\u00e9t c\u00e1c \u0111i\u1ec7n c\u1ef1c b\u1ecb r\u01a1i ra.<\/p>\n<h3>3.4 Nh\u1ecbp tim:<\/h3>\n<p>Theo d\u00f5i nh\u1ecbp tim li\u00ean t\u1ee5c tr\u00ean mornitor nh\u1eb1m ph\u00e1t hi\u1ec7n c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp s\u1edbm sau ph\u1eabu thu\u1eadt tim h\u1edf.<\/p>\n<h3>3.5 L\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u:<\/h3>\n<p>Theo d\u00f5i m\u00e0u s\u1eafc n\u01b0\u1edbc ti\u1ec3u, th\u1ec3 t\u00edch ra m\u1ed7i gi\u1edd \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n s\u1edbm t\u00ecnh tr\u1ea1ng suy th\u1eadn c\u1ea5p \u0111\u1ec3 k\u1ecbp th\u1eddi \u0111i\u1ec1u tr\u1ecb s\u1edbm.<\/p>\n<h3>3.6. C\u00e1c \u1ed1ng d\u1eabn l\u01b0u:<\/h3>\n<p>T\u01b0\u01a1ng t\u1ef1 theo d\u00f5i l\u01b0\u1ee3ng m\u00e1u ra \u1edf c\u00e1c \u1ed1ng d\u1eabn l\u01b0u m\u1ed7i gi\u1edd.Th\u00f4ng th\u01b0\u1eddng, l\u01b0\u1ee3ng m\u00e1u ch\u1ea3y &gt;200 mL\/gi\u1edd ho\u1eb7c &gt;2 mg\/kg trong hai gi\u1edd li\u00ean ti\u1ebfp li\u00ean quan \u0111\u1ebfn nguy c\u01a1 t\u0103ng \u0111\u1ed9t qu\u1ef5, ph\u1eabu thu\u1eadt l\u1ea1i, th\u1edf m\u00e1y k\u00e9o d\u00e0i v\u00e0 t\u1eed vong khi \u0111\u00f3 c\u1ea7n \u0111\u1ebfn qu\u00e1 tr\u00ecnh truy\u1ec1n m\u00e1u v\u00e0 ch\u1ebf ph\u1ea9m m\u00e1u.Theo d\u00f5i c\u1ea9n th\u1eadn m\u1ee9c \u0111\u1ed9 ch\u1ea3y m\u00e1u sau ph\u1eabu thu\u1eadt \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh ti\u1ebfn \u0111\u1ed9 trong \u0111i\u1ec1u tr\u1ecb ch\u1ea3y m\u00e1u.<\/p>\n<h2><strong>4. K\u1ebft lu\u1eadn<\/strong><\/h2>\n<p>Ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim h\u1edf t\u1ea1i \u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c t\u00edch c\u1ef1c \u0111\u00f2i h\u1ecfi s\u1ef1 gi\u00e1m s\u00e1t c\u1ea9n th\u1eadn trong giai \u0111o\u1ea1n h\u1eadu ph\u1eabu \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a qu\u1ea3n l\u00fd v\u00e0 \u0111\u1ea1t k\u1ebft qu\u1ea3 hi\u1ec7u qu\u1ea3\u00a0 nh\u1ea5t.Vi\u1ec7c hi\u1ec3n th\u1ecb li\u00ean t\u1ee5c c\u1ee7a ECG, huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch x\u00e2m l\u1ea5n, theo d\u00f5i SpO2 v\u00e0 \u0111o l\u01b0\u1ee3ng d\u1ecbch tho\u00e1t ra t\u1eeb c\u00e1c \u1ed1ng d\u1eabn l\u01b0u ng\u1ef1c v\u00e0 \u1ed1ng Foley l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft. Vi\u1ec7c gi\u00e1m s\u00e1t c\u1ea9n th\u1eadn v\u00e0 t\u1ed1i \u01b0u h\u00f3a c\u00e1c k\u1ef9 thu\u1eadt x\u00e2m l\u1ea5n l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t cho b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim h\u1edf.<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/\"><strong>B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/strong><\/a> \u0111\u00e3 \u0111\u01b0a h\u1ec7 th\u1ed1ng m\u00e1y m\u00f3c, thi\u1ebft b\u1ecb hi\u1ec7n \u0111\u1ea1i \u0111\u1ea1t chu\u1ea9n v\u00e0o c\u00f4ng t\u00e1c th\u0103m kh\u00e1m, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 ch\u0103m s\u00f3c sau ph\u1eabu thu\u1eadt tim.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ch\u0103m s\u00f3c sau ph\u1eabu thu\u1eadt quan tr\u1ecdng\u00a0 khi ca ph\u1eabu thu\u1eadt k\u1ebft th\u00fac.\u00a0 C\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111\u01b0\u1eddng th\u1edf v\u00e0 th\u00f4ng kh\u00ed, h\u1ea1 huy\u1ebft \u00e1p ho\u1eb7c t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9t ng\u1ed9t, lo\u1ea1n nh\u1ecbp tim, ch\u1ea3y m\u00e1u trung th\u1ea5t t\u0103ng, thay \u0111\u1ed5i thu\u1ed1c v\u00e0 v\u1ea5n \u0111\u1ec1 v\u1ec1 \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n c\u00f3 th\u1ec3 x\u1ea3y ra. 1.Nh\u1eadp [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":19895,"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>Ch\u0103m s\u00f3c sau ph\u1eabu thu\u1eadt tim h\u1edf t\u1ea1i \u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c t\u00edch c\u1ef1c<\/title>\n<meta name=\"description\" content=\"Ch\u0103m s\u00f3c sau ph\u1eabu thu\u1eadt tim h\u1edf t\u1ea1i \u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c t\u00edch c\u1ef1c l\u00e0 v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng v\u00e0 c\u1ea7n thi\u1ebft. 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