{"id":26740,"date":"2023-04-23T21:39:18","date_gmt":"2023-04-23T14:39:18","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26740"},"modified":"2023-04-23T21:39:18","modified_gmt":"2023-04-23T14:39:18","slug":"hoi-sinh-tim-phoi-nang-cao-o-nguoi-lon","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/hoi-sinh-tim-phoi-nang-cao-o-nguoi-lon\/","title":{"rendered":"H\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao \u1edf ng\u01b0\u1eddi l\u1edbn"},"content":{"rendered":"<h2>1.Th\u1ee9 t\u1ef1 h\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao<\/h2>\n<p>H\u1ed3i sinh tim ph\u1ed5i c\u01a1 b\u1ea3n kh\u00f4ng th\u1ec3 ch\u1eafc ch\u1eafn t\u00e1i l\u1eadp \u0111\u01b0\u1ee3c tu\u1ea7n ho\u00e0n t\u1ef1 nhi\u00ean cho b\u1ec7nh nh\u00e2n. Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, tu\u1ea7n ho\u00e0n t\u1ef1 nhi\u00ean ch\u1ec9 c\u00f3 th\u1ec3 t\u00e1i l\u1eadp \u0111\u01b0\u1ee3c n\u1ebfu c\u00f3 nh\u1eefng bi\u1ec7n ph\u00e1p h\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao nh\u01b0: \u0110\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n \u0111\u1ec3 th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o hi\u1ec7u qu\u1ea3 h\u01a1n, d\u00f9ng c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch, s\u1ed1c \u0111i\u1ec7n ph\u00e1 rung th\u1ea5t, \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp tim ngo\u00e0i c\u01a1 th\u1ec3&#8230; V\u00ec v\u1eady kh\u00f4ng ch\u1eadm tr\u1ec5, c\u1ea7n ti\u1ebfn h\u00e0nh ngay nh\u1eefng k\u1ef9 thu\u1eadt h\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao cho b\u1ec7nh nh\u00e2n m\u1ed9t khi c\u00f3 th\u1ec3.<\/p>\n<ul>\n<li>L\u1eafp monitor theo d\u00f5i b\u1ec7nh nh\u00e2n c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t khi c\u00f3 th\u1ec3 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh r\u1ed1i lo\u1ea1n nh\u1ecbp tim v\u00e0 c\u00f3 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/li>\n<li>\u0110\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n l\u00e0 ph\u01b0\u01a1ng ph\u00e1p t\u1ed1t nh\u1ea5t \u0111\u1ec3 th\u00f4ng kh\u00ed v\u00e0 b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf trong h\u1ed3i sinh tim ph\u1ed5i (kh\u00f4ng th\u1eed \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n n\u1ebfu ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o). \u0110\u1eb7t canuyn ch\u1ed1ng t\u1ee5t l\u01b0\u1ee1i ho\u1eb7c \u1ed1ng th\u00f4ng m\u0169i h\u1ecdng \u0111\u1ec3 th\u00f4ng tho\u00e1ng \u0111\u01b0\u1eddng th\u1edf<\/li>\n<li>\u0110\u1eb7t ngay \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch l\u1edbn: \u0110\u1eb7t catheter t\u0129nh m\u1ea1ch trung t\u00e2m (t\u0129nh m\u1ea1ch c\u1ea3nh trong ho\u1eb7c t\u0129nh m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n) n\u1ebfu c\u00f3 th\u1ec3, v\u00e0 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch.<\/li>\n<li>D\u00f9ng thu\u1ed1c adrenaline: C\u00f3 th\u1ec3 b\u01a1m adrenaline v\u00e0o \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n khi \u0111ang c\u1ea5p c\u1ee9u ng\u1eebng tim cho t\u1edbi khi c\u00f3 \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch. M\u1ed9t s\u1ed1 thu\u1ed1c kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 d\u00f9ng \u0111\u01b0\u1eddng n\u00e0y nh\u01b0 lidocaine n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nh\u1ecbp nhanh th\u1ea5t ho\u1eb7c rung th\u1ea5t (tr\u1eeb c\u00e1c mu\u1ed1i bicarbonat v\u00e0 canxi). C\u1ea7n t\u0103ng g\u1ea5p \u0111\u00f4i li\u1ec1u c\u00e1c thu\u1ed1c n\u1ebfu b\u01a1m qua \u0111\u01b0\u1eddng kh\u00ed qu\u1ea3n, v\u00ec s\u1ef1 h\u1ea5p thu thu\u1ed1c k\u00e9m h\u01a1n \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch.<\/li>\n<li>Adrenaline 1 mg ti\u00eam t\u0129nh m\u1ea1ch, nh\u1eafc l\u1ea1i m\u1ed7i 3 &#8211; 5 ph\u00fat<\/li>\n<li>S\u1eed d\u1ee5ng li\u1ec1u adrenaline 2 &#8211; 3 mg n\u1ebfu b\u01a1m qua \u0111\u01b0\u1eddng kh\u00ed qu\u1ea3n, nh\u1eafc l\u1ea1i m\u1ed7i 3 &#8211; 5 ph\u00fat cho \u0111\u1ebfn khi khi \u0111\u1eb7t \u0111\u01b0\u1ee3c \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1eb7c t\u00e1i l\u1eadp \u0111\u01b0\u1ee3c tu\u1ea7n ho\u00e0n.<\/li>\n<\/ul>\n<p><img decoding=\"async\" loading=\"lazy\" class=\" wp-image-26745 aligncenter\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20190917_172657_645452_dat-ong-noi-khi-qua.max-1800x1800-1-300x186.jpg\" alt=\"H\u1ed3i sinh tim ph\u1ed5i\" width=\"379\" height=\"235\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20190917_172657_645452_dat-ong-noi-khi-qua.max-1800x1800-1-300x186.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20190917_172657_645452_dat-ong-noi-khi-qua.max-1800x1800-1-768x475.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20190917_172657_645452_dat-ong-noi-khi-qua.max-1800x1800-1.jpg 810w\" sizes=\"(max-width: 379px) 100vw, 379px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>\u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n l\u00e0 m\u1ed9t trong nh\u1eefng b\u01b0\u1edbc h\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao<\/strong><\/p>\n<h2>2.Ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n sau h\u1ed3i sinh tim ph\u1ed5i<\/h2>\n<ul>\n<li>C\u1ea7n c\u1ed1 g\u1eafng t\u00ecm nguy\u00ean nh\u00e2n g\u00e2y ra ho\u1eb7c th\u00fac \u0111\u1ea9y ng\u1eebng tu\u1ea7n ho\u00e0n b\u1eb1ng c\u00e1ch khai th\u00e1c k\u1ef9 ti\u1ec1n s\u1eed b\u1ec7nh c\u1ee7a b\u1ec7nh nh\u00e2n, di\u1ec5n bi\u1ebfn, bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi ng\u1eebng tu\u1ea7n ho\u00e0n t\u1eeb nh\u1eefng ng\u01b0\u1eddi th\u00e2n trong gia \u0111\u00ecnh, b\u1ea1n b\u00e8, \u0111\u1ed3ng nghi\u1ec7p, t\u1eeb nh\u1eefng ng\u01b0\u1eddi ch\u1ee9ng ki\u1ebfn v\u00e0 nh\u1eefng ghi ch\u00e9p trong h\u1ed3 s\u01a1, s\u1ed5 y b\u1ea1 c\u1ee7a b\u1ec7nh nh\u00e2n&#8230;<\/li>\n<li>Ph\u00e1t hi\u1ec7n v\u00e0 ghi nh\u1eadn nh\u1eefng b\u1ec7nh l\u00fd m\u00e0 c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ng\u1eebng tu\u1ea7n ho\u00e0n (nh\u01b0 nh\u1ed3i m\u00e1u c\u01a1 tim tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, troponin m\u00e1u t\u0103ng, nh\u1eefng bi\u1ec3u hi\u1ec7n thi\u1ebfu oxy c\u1ea5p t\u00ednh trong c\u00e1c b\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, \u0111\u1ed9t qu\u1ef5 n\u00e3o, ng\u1ed9 \u0111\u1ed9c ho\u1eb7c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c, r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i..Ghi ch\u00e9p c\u1ee5 th\u1ec3, t\u1ec9 m\u1ec9 th\u1eddi gian ng\u1eebng tu\u1ea7n ho\u00e0n, c\u00e1c b\u01b0\u1edbc ti\u1ebfn h\u00e0nh c\u1ea5p c\u1ee9u, can thi\u1ec7p, c\u00e1c thu\u1ed1c v\u00e0 li\u1ec1u l\u01b0\u1ee3ng theo th\u1ee9 t\u1ef1 th\u1eddi gian v\u00e0o h\u1ed3 s\u01a1 b\u1ec7nh \u00e1n.<\/li>\n<\/ul>\n<h2><strong><em>3.Kh\u00e1m v\u00e0 theo d\u00f5i l\u00e2m s\u00e0ng:<\/em><\/strong><\/h2>\n<ul>\n<li>Ki\u1ec3m tra th\u00f4ng kh\u00ed 2 ph\u1ed5i, ph\u00e1t hi\u1ec7n d\u1ea5u hi\u1ec7u g\u00e3y x\u01b0\u01a1ng s\u01b0\u1eddn trong khi \u00e9p tim.<\/li>\n<li>Nghe tim \u0111\u1ec3 ph\u00e1t hi\u1ec7n ti\u1ebfng tim b\u1ea5t th\u01b0\u1eddng, ti\u1ebfng th\u1ed5i \u1edf tim, kh\u00e1m v\u00e0 ki\u1ec3m tra d\u1ea5u hi\u1ec7u t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i.<\/li>\n<li>Kh\u00e1m b\u1ee5ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n d\u1ea5u hi\u1ec7u t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng v\u00e0 c\u00e1c b\u1ea5t th\u01b0\u1eddng c\u1ee7a c\u00e1c t\u1ea1ng nh\u01b0 gan, th\u1eadn&#8230;<\/li>\n<li>\u0110\u1eb7t \u1ed1ng th\u00f4ng b\u00e0ng quang \u0111\u1ec3 theo d\u00f5i n\u01b0\u1edbc ti\u1ec3u.<\/li>\n<li>Xem x\u00e9t \u0111\u1eb7t \u1ed1ng th\u00f4ng d\u1ea1 d\u00e0y \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y v\u00e0 nu\u00f4i d\u01b0\u1ee1ng n\u1ebfu b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea.<\/li>\n<li>\u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 h\u00f4n m\u00ea theo thang \u0111i\u1ec3m Glasgow v\u00e0 th\u0103m kh\u00e1m th\u1ea7n kinh, ph\u00e1t hi\u1ec7n d\u1ea5u hi\u1ec7u th\u1ea7n kinh khu tr\u00fa \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u00e3o&#8230;<\/li>\n<\/ul>\n<h2>4.C\u00e1c th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng:<\/h2>\n<ul>\n<li>Ghi \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 (t\u00ecm ki\u1ebfm d\u1ea5u hi\u1ec7u nh\u1ed3i m\u00e1u c\u01a1 tim, s\u00f3ng T cao trong t\u0103ng kali m\u00e1u, c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim nh\u01b0 nh\u1ecbp nhanh th\u1ea5t, rung th\u1ea5t&#8230;)<\/li>\n<li>L\u00e0m kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, ure m\u00e1u, \u0111\u01b0\u1eddng m\u00e1u, \u0111\u00f4ng m\u00e1u&#8230;<\/li>\n<li>Ch\u1ee5p phim X-quang ng\u1ef1c (ki\u1ec3m tra v\u1ecb tr\u00ed \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, t\u00ecm ki\u1ebfm d\u1ea5u hi\u1ec7u tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, trung th\u1ea5t r\u1ed9ng \u1edf b\u1ec7nh nh\u00e2n t\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, g\u00e3y x\u01b0\u01a1ng s\u01b0\u1eddn&#8230;)<\/li>\n<li>Si\u00eau \u00e2m tim \u0111\u00e1nh gi\u00e1 v\u1eadn \u0111\u1ed9ng th\u00e0nh tim, tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim.<\/li>\n<li>Lu\u00f4n nh\u1edb trao \u0111\u1ed5i k\u1ef9 l\u01b0\u1ee1ng t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n v\u1edbi ng\u01b0\u1eddi th\u00e2n c\u1ee7a h\u1ecd \u0111\u1ec3 h\u1ecd bi\u1ebft \u0111\u01b0\u1ee3c th\u00f4ng tin v\u1ec1 c\u00e1c bi\u1ebfn c\u1ed1, t\u00ecnh h\u00ecnh hi\u1ec7n t\u1ea1i, nh\u1eefng c\u00f4ng vi\u1ec7c ti\u1ebfp t\u1ee5c ti\u1ebfn h\u00e0nh v\u00e0 nh\u1eefng di\u1ec5n bi\u1ebfn, k\u1ebft c\u1ee5c c\u00f3 th\u1ec3 x\u1ea3y ra v\u1edbi b\u1ec7nh nh\u00e2n.<\/li>\n<li>V\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n m\u1ea5t n\u00e3o, c\u00e2n nh\u1eafc kh\u1ea3 n\u0103ng hi\u1ebfn t\u1ea1ng v\u00e0 trao \u0111\u1ed5i v\u1edbi ng\u01b0\u1eddi th\u00e2n c\u1ee7a b\u1ec7nh nh\u00e2n. K\u1ec3 c\u1ea3 khi vi\u1ec7c trao \u0111\u1ed5i v\u1edbi ng\u01b0\u1eddi th\u00e2n b\u1ecb tr\u00ec ho\u00e3n, lu\u00f4n nh\u1edb r\u1eb1ng gi\u00e1c m\u1ea1c v\u00e0 van tim c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u1edbi 24 gi\u1edd sau t\u1eed vong.<\/li>\n<\/ul>\n<h2>5.M\u1ed9t s\u1ed1 \u0111i\u1ec3m c\u1eadp nh\u1eadt v\u00e0 l\u01b0u \u00fd trong h\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao (theo AHA 2015 v\u00e0 c\u1eadp nh\u1eadt n\u0103m 2018)<\/h2>\n<ul>\n<li>D\u00f9ng vasopressin k\u1ebft h\u1ee3p v\u1edbi ,adrenaline kh\u00f4ng l\u00e0m thay \u0111\u1ed5i hi\u1ec7u qu\u1ea3 c\u0169ng nh\u01b0 t\u1ed5ng li\u1ec1u adrenaline c\u1ea7n d\u00f9ng trong c\u1ea5p c\u1ee9u ng\u1eebng tu\u1ea7n ho\u00e0n, v\u00ec v\u1eady khuy\u1ebfn c\u00e1o c\u1ee7a H\u1ed9i Tim m\u1ea1ch h\u1ecdc Hoa K\u1ef3 (AHA) 2015 \u0111\u00e3 lo\u1ea1i vasopressin kh\u1ecfi ph\u00e1c \u0111\u1ed3 c\u1ea5p c\u1ee9u.<\/li>\n<li>C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng ETCO\u2082 (End-tidal CO2 &#8211; N\u1ed3ng \u0111\u1ed9\/ \u00e1p l\u1ef1c CO 2 cu\u1ed1i th\u00ec th\u1edf ra) \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n nh\u01b0 m\u1ed9t ch\u1ec9 s\u1ed1 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ea5p c\u1ee9u ng\u1eebng tu\u1ea7n ho\u00e0n. ETCO\u2082 sau c\u1ea5p c\u1ee9u 20 ph\u00fat th\u1ea5p d\u01b0\u1edbi 10 mmHg l\u00e0 m\u1ed9t trong c\u00e1c ti\u00eau chu\u1ea9n \u0111\u1ec3 xem x\u00e9t ng\u1eebng c\u1ea5p c\u1ee9u.<\/li>\n<li>Glucocorticoid c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i khi s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi vasopressin v\u00e0 adrenaline trong \u0111i\u1ec1u tr\u1ecb ng\u1eebng tu\u1ea7n ho\u00e0n trong b\u1ec7nh vi\u1ec7n. Tuy nhi\u00ean kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng glucocorticoid th\u01b0\u1eddng quy v\u00ec ch\u01b0a ch\u1ee9ng minh \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 qua c\u00e1c nghi\u00ean c\u1ee9u theo d\u00f5i sau ng\u1eebng tu\u1ea7n ho\u00e0n.<\/li>\n<li>C\u00e1c p ph\u01b0\u01a1ng ti\u1ec7n \u00e9p tim ngo\u00e0i c\u01a1 th\u1ec3 c\u00f3 th\u1ec3 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng c\u00f2n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y ng\u1eebng tu\u1ea7n ho\u00e0n ho\u1eb7c chu\u1ea9n b\u1ecb \u0111\u1eb7t ECMO (oxy h\u00f3a m\u00e1u qua m\u00e0ng ngo\u00e0i c\u01a1 the) hay gh\u00e9p tim cho c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c.<\/li>\n<li>V\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n ng\u1eebng tim v\u1edbi r\u1ed1i lo\u1ea1n nh\u1ecbp tim m\u00e0 kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh s\u1ed1c \u0111i\u1ec7n n\u00ean d\u00f9ng adrenaline s\u1edbm.<\/li>\n<li>Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng lidocaine th\u01b0\u1eddng quy. C\u00e2n nh\u1eafc b\u1eaft \u0111\u1ea7u ho\u1eb7c ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng lidocaine sau nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ng\u1eebng tim do rung th\u1ea5t hay nh\u1ecbp nhanh th\u1ea5t.<\/li>\n<li>N\u0103m 2018, \u0111\u1ed3ng thu\u1eadn qu\u1ed1c t\u1ebf v\u1ec1 h\u1ed3i sinh tim ph\u1ed5i v\u00e0 c\u1ea5p c\u1ee9u tim m\u1ea1ch: Amiodarone ho\u1eb7c lidocaine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p rung th\u1ea5t ho\u1eb7c nh\u1ecbp nhanh th\u1ea5t v\u00f4 m\u1ea1ch kh\u00e1ng tr\u1ecb v\u1edbi s\u1ed1c \u0111i\u1ec7n. Tuy nhi\u00ean b\u1eb1ng ch\u1ee9ng v\u1ec1 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c chong lo\u1ea1n nh\u1ecbp b\u1ecb h\u1ea1 xu\u1ed1ng.<\/li>\n<li>Li\u1ec1u l\u01b0\u1ee3ng c\u1ee5 th\u1ec3: Amiodarone 300 mg bolus, l\u1eb7p l\u1ea1i li\u1ec1u 150 mg t\u0129nh m\u1ea1ch. Lidocaine 1 &#8211; 1,5 mg\/kg bolus, sau \u0111\u00f3 0,5 &#8211; 0,75 mg\/kg m\u1ed7i 5 &#8211; 10 ph\u00fat.<\/li>\n<li>Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng magie sulfate th\u01b0\u1eddng quy trong c\u1ea5p c\u1ee9u ng\u1eebng tu\u1ea7n ho\u00e0n. C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p xo\u1eafn \u0111\u1ec9nh.<\/li>\n<li>S\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m: C\u00f3 th\u1ec3 xem x\u00e9t s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m theo \u0111\u01b0\u1eddng u\u1ed1ng hay ti\u00eam \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ng\u1eebng tu\u1ea7n ho\u00e0n do rung th\u1ea5t hay nh\u1ecbp nhanh th\u1ea5t. S\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m trong c\u1ea5p c\u1ee9u ng\u1eebng tu\u1ea7n ho\u00e0n \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t do m\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00f3 m\u1ed1i li\u00ean h\u1ec7 gi\u1eefa t\u1ef7 l\u1ec7 s\u1ed1ng cao h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng thu\u1ed1c. Tuy nhi\u00ean, kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c th\u01b0\u1eddng quy v\u00ec c\u00f3 th\u1ec3 g\u00e2y r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng, l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng suy tim c\u1ea5p t\u00ednh, hay g\u00e2y nh\u1ecbp ch\u1eadm. Vi\u1ec7c d\u00f9ng ch\u1eb9n beta giao c\u1ea3m c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t tr\u00ean t\u1eebng b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3.<\/li>\n<li>N\u00ean ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t ,cho c\u00e1c b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u c\u01a1,tim c\u1ea5p c\u00f3 ST ch\u00eanh l\u00ean ho\u1eb7c kh\u00f4ng c\u00f3 ST ch\u00eanh l\u00ean nh\u01b0ng c\u00f3 huy\u1ebft \u0111\u1ed9ng hay \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 kh\u00f4ng \u1ed5n \u0111\u1ecbnh m\u00e0 ngh\u0129 nhi\u1ec1u \u0111\u1ebfn nguy\u00ean nh\u00e2n do h\u1eb9p t\u1eafc \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/li>\n<li>H\u1ea1 th\u00e2n nhi\u1ec7t ch\u1ec9 huy \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 trong b\u1ea3o v\u1ec7 n\u00e3o, m\u1ee9c nhi\u1ec7t \u0111\u1ed9 t\u1eeb 34\u2070C \u0111\u1ebfn 36\u2070C c\u00f3 th\u1ec3 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c, kh\u00f4ng qu\u00e1 36\u2070C.<\/li>\n<li>M\u1ee5c ti\u00eau huy\u1ebft \u0111\u1ed9ng: Huy\u1ebft \u00e1p trung b\u00ecnh kh\u00f4ng \u0111\u01b0\u1ee3c d\u01b0\u1edbi 65 mmHg, n\u00ean \u0111i\u1ec1u ch\u1ec9nh duy tr\u00ec huy\u1ebft \u00e1p trung b\u00ecnh t\u1eeb 80 &#8211; 100 mmHg \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o t\u01b0\u1edbi m\u00e1u n\u00e3o.<\/li>\n<\/ul>\n<p>Sau giai \u0111o\u1ea1n h\u1ea1 th\u00e2n nhi\u1ec7t, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 s\u1ed1t. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng thu\u1ed1c h\u1ea1 s\u1ed1t n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/p>\n<p>R\u1ed1i lo\u1ea1n nh\u1ecbp tim trong ng\u1eebng tu\u1ea7n ho\u00e0n c\u00f3 th\u1ec3 chia \u0111\u01b0\u1ee3c th\u00e0nh 2 nh\u00f3m:<\/p>\n<ul>\n<li><strong>Rung th\u1ea5t v\u00e0 nh\u1ecbp nhanh th\u1ea5t v\u00f4 m\u1ea1ch <\/strong>( ventricular fibrillation\/pulseless ventricular tachycardia &#8211; VF\/pVT)<\/li>\n<li><strong>C\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim kh\u00e1c: <\/strong>V\u00f4 t\u00e2m thu v\u00e0 ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n v\u00f4 m\u1ea1ch (pulseless electrical activity &#8211; PEA)<\/li>\n<\/ul>\n<p>S\u1ef1 kh\u00e1c nhau ch\u00ednh trong \u0111i\u1ec1u tr\u1ecb c\u1ee7a 2 nh\u00f3m r\u1ed1i lo\u1ea1n nh\u1ecbp tim l\u00e0 <strong>s\u1ed1c \u0111i\u1ec7n ph\u00e1 rung <\/strong>trong nh\u00f3m b\u1ec7nh nh\u00e2n rung th\u1ea5t\/nh\u1ecbp nhanh th\u1ea5t v\u00f4 m\u1ea1ch.<\/p>\n<ul>\n<li><strong>Rung th\u1ea5t v\u00e0 nh\u1ecbp nhanh th\u1ea5t v\u00f4 m\u1ea1ch<\/strong><\/li>\n<\/ul>\n<ol>\n<li>Rung th\u1ea5t, nh\u1ecbp nhanh th\u1ea5t v\u00f4 m\u1ea1ch l\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp tim th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf th\u1eddi \u0111i\u1ec3m ng\u1eebng tim.<\/li>\n<li>Th\u00e0nh c\u00f4ng trong \u0111i\u1ec1u tr\u1ecb rung th\u1ea5t\/nh\u1ecbp nhanh th\u1ea5t v\u00f4 m\u1ea1ch ph\u1ee5 thu\u1ed9c r\u1ea5t nhi\u1ec1u v\u00e0o ch\u1ec9 \u0111\u1ecbnh s\u1ed1c \u0111i\u1ec7n ph\u00e1 rung ngay l\u1eadp t\u1ee9c. Ch\u1eadm s\u1ed1c \u0111i\u1ec7n m\u1ed7i ph\u00fat, t\u1ef7 l\u1ec7 s\u1ed1c \u0111i\u1ec7n th\u00e0nh c\u00f4ng gi\u1ea3m 7 &#8211; 10%.<\/li>\n<li>\u0110\u1ea5m m\u1ea1nh ng\u1ef1c: Tr\u01b0\u1edbc khi ,\u00e9p tim, n\u00ean d\u00f9ng n\u1eafm tay \u0111\u1ea5m m\u1ea1nh v\u00e0o x\u01b0\u01a1ng \u1ee9c b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 chuy\u1ec3n nh\u1ecbp v\u1ec1 nh\u1ecbp \u0111\u1eadp b\u00ecnh th\u01b0\u1eddng c\u1ee7a tim. Nh\u00e1t \u0111\u1ea5m n\u00e0y c\u00f3 th\u1ec3 r\u1ea5t hi\u1ec7u qu\u1ea3 trong v\u00f2ng 30 gi\u00e2y sau ng\u1eebng tim.<\/li>\n<li>Khuy\u1ebfn c\u00e1o n\u00ean s\u1eed d\u1ee5ng m\u00e1y s\u1ed1c \u0111i\u1ec7n hai pha, li\u1ec1u kh\u1edfi \u0111\u1ea7u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o theo h\u01b0\u1edbng d\u0201n c\u1ee7a nh\u00e0 s\u1ea3n xu\u1ea5t. N\u1ebfu kh\u00f4ng bi\u1ebft r\u00f5, n\u00ean s\u1eed d\u1ee5ng li\u1ec1u cao nh\u1ea5t c\u00f3 th\u1ec3.<\/li>\n<li>C\u1ea7n ti\u1ebfp t\u1ee5c \u00e9p tim ngay sau khi s\u1ed1c \u0111i\u1ec7n m\u00e0 kh\u00f4ng c\u1ea7n ki\u1ec3m tra m\u1ea1ch. Ch\u1ec9 n\u00ean d\u1eebng \u00e9p v\u00e0 ki\u1ec3m tra m\u1ea1ch sau m\u1ed7i 2 ph\u00fat \u00e9p tim, kh\u00f4ng ki\u1ec3m tra m\u1ea1ch n\u1ebfu m\u00e1y ph\u00e1 rung ch\u01b0a \u0111\u01b0\u1ee3c s\u1ea1c \u0111\u1ea7y v\u00e0 s\u1eb5n s\u00e0ng s\u1ed1c \u0111i\u1ec7n n\u1ebfu nh\u1ecbp v\u0201n c\u00f2n l\u00e0 nh\u1ecbp nhanh th\u1ea5t v\u00f4 m\u1ea1ch ho\u1eb7c rung th\u1ea5t.<\/li>\n<li>L\u1eb7p l\u1ea1i s\u1ed1c \u0111i\u1ec7n n\u1ebfu nhanh th\u1ea5t\/rung th\u1ea5t dai d\u1eb3ng.<\/li>\n<li>\u00c9p tim v\u00e0 h\u00f4 h\u1ea5p nh\u00e2n t\u1ea1o ngay sau m\u1ed7i l\u1ea7n s\u1ed1c n\u1ebfu ch\u01b0a t\u00e1i l\u1eadp nh\u1ecbp tim t\u1ea1o ra huy\u1ebft \u0111\u1ed9ng duy tr\u00ec s\u1ef1 s\u1ed1ng cho n\u00e3o v\u00e0 tim.<\/li>\n<li>Gi\u1eefa c\u00e1c l\u1ea7n s\u1ed1c \u0111i\u1ec7n, c\u1ea7n ti\u1ebfp t\u1ee5c ti\u1ebfn h\u00e0nh nh\u1eefng k\u1ef9 thu\u1eadt h\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao nh\u01b0: \u0110\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, \u0111\u1eb7t catheter t\u0129nh m\u1ea1ch trung t\u00e2m, \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh (xem d\u01b0\u1edbi), ph\u00e2n t\u00edch v\u00e0 \u0111i\u1ec1u ch\u1ec9nh kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 v\u00e0 th\u0103ng b\u1eb1ng ki\u1ec1m toan&#8230;<\/li>\n<li>Adrenaline n\u00ean d\u00f9ng m\u1ed7i 3 &#8211; 5 ph\u00fat (1 mg ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c 2 &#8211; 3 mg qua \u0111\u01b0\u1eddng n\u1ed9i kh\u00ed qu\u1ea3n).<\/li>\n<\/ol>\n<ul>\n<li><strong>V\u00f4 t\u00e2m thu v\u00e0 ho\u1ea1t \u0111\u1ed9ng \u0111i\u1ec7n v\u00f4 m\u1ea1ch<\/strong><\/li>\n<\/ul>\n<p>K\u1ebft qu\u1ea3 c\u1ee7a h\u1ed3i sinh tim ph\u1ed5i v\u1edbi nh\u1eefng r\u1ed1i lo\u1ea1n nh\u1ecbp tim n\u00e0y n\u00f3i chung kh\u00f4ng t\u1ed1t b\u1eb1ng nh\u1ecbp nhanh th\u1ea5t v\u00f4 m\u1ea1ch\/rung th\u1ea5t tr\u1eeb khi kh\u1eafc ph\u1ee5c v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n b\u1ec7nh.<\/p>\n<p><strong><em>Nh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y ng\u1eebng tu\u1ea7n ho\u00e0n c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3:<\/em><\/strong><\/p>\n<p><strong><em>\u00a0<\/em><\/strong><\/p>\n<table style=\"height: 314px;\" width=\"496\">\n<tbody>\n<tr>\n<td width=\"667\">Thi\u1ebfu oxy.<\/p>\n<p>Gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n.<\/p>\n<p>T\u0103ng\/h\u1ea1 kali m\u00e1u v\u00e0 r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a. H\u1ea1 th\u00e2n nhi\u1ec7t.<\/p>\n<p>Tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i.<\/p>\n<p>\u00c9p tim c\u1ea5p.<\/p>\n<p>R\u1ed1i lo\u1ea1n li\u00ean quan \u0111\u1ebfn ng\u1ed9 \u0111\u1ed9c\/\u0111i\u1ec1u tr\u1ecb thu\u1ed1c.<\/p>\n<p>Thuy\u00ean t\u1eafc m\u1ea1ch m\u00e1u, van tim.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><!--more--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>1.Th\u1ee9 t\u1ef1 h\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao H\u1ed3i sinh tim ph\u1ed5i c\u01a1 b\u1ea3n kh\u00f4ng th\u1ec3 ch\u1eafc ch\u1eafn t\u00e1i l\u1eadp \u0111\u01b0\u1ee3c tu\u1ea7n ho\u00e0n t\u1ef1 nhi\u00ean cho b\u1ec7nh nh\u00e2n. Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, tu\u1ea7n ho\u00e0n t\u1ef1 nhi\u00ean ch\u1ec9 c\u00f3 th\u1ec3 t\u00e1i l\u1eadp \u0111\u01b0\u1ee3c n\u1ebfu c\u00f3 nh\u1eefng bi\u1ec7n ph\u00e1p h\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao nh\u01b0: \u0110\u1eb7t [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[23,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>H\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao \u1edf ng\u01b0\u1eddi l\u1edbn<\/title>\n<meta name=\"description\" content=\"H\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao khi h\u1ed3i sinh tim ph\u1ed5i c\u01a1 b\u1ea3n kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c. Tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y v\u1ec1 c\u00e1c b\u01b0\u1edbc th\u1ef1c hi\u1ec7n.\" \/>\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=\"H\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao \u1edf ng\u01b0\u1eddi l\u1edbn\" \/>\n<meta property=\"og:description\" content=\"H\u1ed3i sinh tim ph\u1ed5i n\u00e2ng cao khi h\u1ed3i sinh tim ph\u1ed5i c\u01a1 b\u1ea3n kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c. 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