{"id":2724,"date":"2023-04-10T19:09:48","date_gmt":"2023-04-10T12:09:48","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2724"},"modified":"2023-04-19T15:00:51","modified_gmt":"2023-04-19T08:00:51","slug":"giam-dau-sau-hau-phau-phau-thuat-tim-ho","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/giam-dau-sau-hau-phau-phau-thuat-tim-ho\/","title":{"rendered":"Gi\u1ea3m \u0111au sau h\u1eadu ph\u1eabu ph\u1eabu thu\u1eadt tim h\u1edf"},"content":{"rendered":"<p><strong>Gi\u1ea3m \u0111au sau ph\u1eabu thu\u1eadt tim h\u1edf l\u00e0 y\u1ebfu t\u1ed1 gi\u00fap c\u1ea3i thi\u1ec7n sau ph\u1eabu thu\u1eadt. Vi\u1ec7c ki\u1ec3m so\u00e1t \u0111au l\u00e0m gi\u1ea3m ph\u1ea3n \u1ee9ng th\u1ea7n kinh giao c\u1ea3m, l\u00e0m gi\u1ea3m nguy c\u01a1 thi\u1ebfu m\u00e1u c\u01a1 tim v\u00e0 nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p, t\u00e2m l\u00fd t\u1ed5ng th\u1ec3 v\u00e0 ph\u1ee5c h\u1ed3i th\u1ec3 ch\u1ea5t c\u1ee7a b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt. \u0110au th\u01b0\u1eddng r\u1ea5t n\u1ed5i b\u1eadt khi ho ho\u1eb7c th\u1edf s\u00e2u. \u0110au th\u01b0\u1eddng gi\u1ea3m sau khi lo\u1ea1i b\u1ecf c\u00e1c \u1ed1ng d\u1eabn l\u01b0u.<\/strong><\/p>\n<h2>1.Gi\u1edbi thi\u1ec7u v\u1ec1 gi\u1ea3m \u0111au sau ph\u1eabu thu\u1eadt:<\/h2>\n<p>Gi\u1ea3m \u0111au sau ph\u1eabu thu\u1eadt tim l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng trong vi\u1ec7c ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n. Ph\u1eabu thu\u1eadt tim l\u00e0 m\u1ed9t ph\u1eabu thu\u1eadt l\u1edbn, \u0111\u00f2i h\u1ecfi m\u1ed9t th\u1eddi gian ph\u1ee5c h\u1ed3i d\u00e0i v\u00e0 \u0111\u00f4i khi g\u00e2y ra \u0111au v\u00e0 kh\u00f3 ch\u1ecbu. Vi\u1ec7c ki\u1ec3m so\u00e1t \u0111au sau ph\u1eabu thu\u1eadt tim l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c nhanh ch\u00f3ng v\u00e0 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn \u0111au.<\/p>\n<p>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m \u0111au sau ph\u1eabu thu\u1eadt tim bao g\u1ed3m s\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3m \u0111au, \u0111\u01b0\u1eddng t\u1ee7y s\u1ed1ng v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m \u0111au kh\u00e1c. Th\u01b0\u1eddng th\u00ec thu\u1ed1c gi\u1ea3m \u0111au opioid \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m \u0111au sau ph\u1eabu thu\u1eadt tim. Ngo\u00e0i ra, c\u0169ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c nh\u01b0 acetaminophen v\u00e0 ibuprofen \u0111\u1ec3 h\u1ed7 tr\u1ee3 gi\u1ea3m \u0111au v\u00e0 gi\u1ea3m nguy c\u01a1 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c opioid.<\/p>\n<p>Ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m \u0111au \u0111\u01b0\u1eddng t\u1ee7y s\u1ed1ng c\u0169ng l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 gi\u1ea3m \u0111au sau ph\u1eabu thu\u1eadt tim. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y bao g\u1ed3m vi\u1ec7c ti\u00eam thu\u1ed1c gi\u1ea3m \u0111au tr\u1ef1c ti\u1ebfp v\u00e0o \u0111\u01b0\u1eddng t\u1ee7y s\u1ed1ng \u0111\u1ec3 gi\u1ea3m \u0111au v\u00e0 gi\u1ea3m nguy c\u01a1 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c khi so s\u00e1nh v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3m \u0111au qua \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n<p>B\u00ean c\u1ea1nh \u0111\u00f3, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m \u0111au kh\u00e1c nh\u01b0 massage, yoga v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m \u0111au t\u1ef1 nhi\u00ean kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 gi\u1ea3m \u0111au sau ph\u1eabu thu\u1eadt tim.<\/p>\n<h2><strong>2. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m \u0111au sau ph\u1eabu thu\u1eadt.<\/strong><\/h2>\n<h3>2.1 Khi c\u00f2n \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n<\/h3>\n<ul>\n<li>Ph\u01b0\u01a1ng ph\u00e1p nh\u01b0\u00a0 d\u00f9ng h\u1ec7 th\u1ed1ng gi\u1ea3m \u0111au ON-Q Pain Relief System v\u1edbi bupivacaine 0,5% 4 mL\/gi\u1edd c\u00f3 th\u1ec3 gi\u1ea3m \u0111au v\u00f9ng x\u01b0\u01a1ng \u1ee9c v\u00e0 gi\u1ea3m nhu c\u1ea7u d\u00f9ng thu\u1ed1c gi\u1ea3m \u0111au opioid. \u0110i\u1ec1u n\u00e0y c\u00f3 l\u1ee3i \u0111\u1eb7c bi\u1ec7t khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c r\u00fat \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n ngay trong ph\u00f2ng m\u1ed5.<\/li>\n<li>Trong khi b\u1ec7nh nh\u00e2n c\u00f2n \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, thu\u1ed1c gi\u1ea3m \u0111au g\u00e2y m\u00ea trong ph\u1eabu thu\u1eadt c\u00f2n c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au, nh\u01b0ng propofol kh\u00f4ng ph\u1ea3i l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au v\u00e0 c\u00f3 th\u1ec3 c\u1ea7n s\u1eed d\u1ee5ng th\u00eam c\u00e1c lo\u1ea1i thu\u1ed1c gi\u1ea3m \u0111au v\u00e0o th\u1eddi \u0111i\u1ec3m r\u00fat \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n. Dexmedetomidine c\u00f3 l\u1ee3i \u00edch \u1edf ch\u1ed7 n\u00f3 c\u00f3 t\u00ednh gi\u1ea3m \u0111au v\u00e0 an th\u1ea7n. S\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3m \u0111au opioid ph\u00f9 h\u1ee3p v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 th\u1edf m\u00e1y k\u00e9o d\u00e0i. Tuy nhi\u00ean, n\u1ebfu r\u00fat \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n \u0111\u01b0\u1ee3c d\u1ef1 ki\u1ebfn s\u1edbm, m\u1ed9t lo\u1ea1t c\u00e1c ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m \u0111au c\u00f3 th\u1ec3 gi\u1ea3m ho\u1eb7c lo\u1ea1i b\u1ecf nhu c\u1ea7u s\u1eed d\u1ee5ng opioid v\u00e0o th\u1eddi \u0111i\u1ec3m r\u00fat \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u00e0y bao g\u1ed3m s\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3m \u0111au kh\u00f4ng steroid nh\u01b0 ketorolac 30 mg (IV) v\u00e0 paracetamol (IV).<\/li>\n<\/ul>\n<h3>2.2 Sau khi r\u00fat \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n:<\/h3>\n<ul>\n<li>S\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c gi\u1ea3m \u0111au kh\u00f4ng opioid lu\u00f4n l\u00e0 t\u1ed1t nh\u1ea5t v\u00e0 c\u00f3 th\u1ec3 cung c\u1ea5p gi\u1ea3m \u0111au \u0111\u1ee7 m\u1ee9c \u0111\u1ed9 cho h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n nh\u01b0 Ketorolac (15-30mg IV) trong v\u00f2ng 72 gi\u1edd ho\u1eb7c Paracetamol IV.<\/li>\n<li>Paracetamol th\u01b0\u1eddng gi\u1ea3m \u0111au \u0111\u1ee7 m\u1ee9c cho b\u1ec7nh nh\u00e2n trong v\u00e0i ng\u00e0y \u0111\u1ea7u sau \u0111\u00f3 c\u00f3 th\u1ec3 chuy\u1ec3n sang s\u1eed d\u1ee5ng thu\u1ed1c gi\u1ea3m \u0111au qua \u0111\u01b0\u1eddng u\u1ed1ng. Gabapentin 300 mg, t\u1ed1i \u0111a ba l\u1ea7n m\u1ed7i ng\u00e0y, th\u01b0\u1eddng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111au d\u00e2y th\u1ea7n kinh, nh\u01b0ng n\u00f3 c\u0169ng th\u01b0\u1eddng h\u1eefu \u00edch trong vi\u1ec7c cung c\u1ea5p gi\u1ea3m \u0111au ngay sau ph\u1eabu thu\u1eadt. Tramadol 50-100mg m\u1ed7i 4-6 gi\u1edd c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t.<\/li>\n<li>V\u1ec1 ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m \u0111au b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng m\u00e1y ti\u00eam t\u0129nh m\u1ea1ch do b\u1ec7nh nh\u00e2n t\u1ef1 \u0111i\u1ec1u ch\u1ec9nh (PCA), nhi\u1ec1u lo\u1ea1i thu\u1ed1c gi\u1ea3m \u0111au opioid c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 cung c\u1ea5p gi\u1ea3m \u0111au hi\u1ec7u qu\u1ea3. M\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng morphine (1mg bolus v\u00e0 0,3mg\/h truy\u1ec1n t\u0129nh m\u1ea1ch), fentanyl (10mcg bolus v\u00e0 1mcg\/kg\/h truy\u1ec1n t\u0129nh m\u1ea1ch) ho\u1eb7c remifentanil (0,5mg\/kg bolus v\u00e0 0,05mcg\/kg\/ph\u00fat truy\u1ec1n t\u0129nh m\u1ea1ch) b\u1eaft \u0111\u1ea7u sau khi ph\u1eabu thu\u1eadt ho\u00e0n t\u1ea5t trong v\u00f2ng 24 gi\u1edd cung c\u1ea5p gi\u1ea3m \u0111au t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nh\u01b0ng c\u00f3 \u00edt t\u00e1c d\u1ee5ng ph\u1ee5 h\u01a1n khi s\u1eed d\u1ee5ng remifentanil.<\/li>\n<\/ul>\n<h3>2.3 C\u00e1c l\u01b0u \u00fd kh\u00e1c:<\/h3>\n<ul>\n<li>Gi\u1ea3m \u0111au b\u1eb1ng \u0111\u01b0\u1eddng t\u1ee7y s\u1ed1ng v\u1edbi thu\u1ed1c gi\u1ea3m \u0111au opioid v\u00e0 bupivacaine c\u00f3 l\u1ee3i trong vi\u1ec7c gi\u1ea3m \u0111au, gia t\u0103ng kh\u1ea3 n\u0103ng r\u00fat \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh v\u00e0 b\u00e9o ph\u00ec.<\/li>\n<li>M\u1ed9t s\u1ed1 li\u1ec1u thu\u1ed1c gi\u1ea3m \u0111au opioid nh\u1ecf ho\u1eb7c m\u1ed9t li\u1ec1u thu\u1ed1c gi\u1ea3m \u0111au opioid li\u00ean t\u1ee5c (nh\u01b0 morphin sulfat 0,02mg\/kg\/h cho b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 65 tu\u1ed5i v\u00e0 0,01mg\/kg\/h cho b\u1ec7nh nh\u00e2n tr\u00ean 65 tu\u1ed5i) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ec3 gi\u1ea3m \u0111au \u0111\u1ed3ng th\u1eddi gi\u1ea3m thi\u1ec3u suy h\u00f4 h\u1ea5p.<\/li>\n<li>\u0110\u00f4i khi, \u0111au dai d\u1eb3ng kh\u00f3 ch\u1ecbu v\u00e0 kh\u00f4ng th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p tr\u00ean, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 s\u1eed d\u1ee5ng opioid tr\u01b0\u1edbc \u0111\u00f3, c\u00f3 th\u1ec3 c\u1ea7n s\u1eed d\u1ee5ng Hydromorphone t\u0129nh m\u1ea1ch (Dilaudid) 1-2mg m\u1ed7i 2-3 gi\u1edd, nh\u01b0ng c\u00f3 nguy c\u01a1 v\u1ec1 suy h\u00f4 h\u1ea5p ho\u1eb7c mi\u1ebfng d\u00e1n fentanyl (25-50mcg\/h mi\u1ebfng m\u1ed7i 72 gi\u1edd).<\/li>\n<\/ul>\n<h2>3.T\u1ed5ng k\u1ebft v\u1ec1 gi\u1ea3m \u0111au sau ph\u1eabu thu\u1eadt tim h\u1edf:<\/h2>\n<p>Gi\u1ea3m \u0111au hi\u1ec7u qu\u1ea3 sau ph\u1eabu thu\u1eadt tim h\u1edf l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u1ea3m s\u1ef1 kh\u00f3 ch\u1ecbu cho b\u1ec7nh nh\u00e2n, gi\u1ea3m thi\u1ec3u t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c gi\u1ea3m \u0111au opioid v\u00e0 gi\u00fap b\u1ec7nh nh\u00e2n ph\u1ee5c h\u1ed3i nhanh ch\u00f3ng. C\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m \u0111au \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, bao g\u1ed3m s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00f4ng opioid, m\u00e1y ti\u00eam t\u0129nh m\u1ea1ch do b\u1ec7nh nh\u00e2n t\u1ef1 \u0111i\u1ec1u ch\u1ec9nh, \u0111\u01b0\u1eddng t\u1ee7y s\u1ed1ng v\u1edbi thu\u1ed1c gi\u1ea3m \u0111au opioid v\u00e0 bupivacaine. Tuy nhi\u00ean, vi\u1ec7c ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m \u0111au ph\u00f9 h\u1ee3p ph\u1ea3i \u0111\u01b0\u1ee3c xem x\u00e9t k\u1ef9 l\u01b0\u1ee1ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh v\u00e0 b\u00e9o ph\u00ec ho\u1eb7c \u0111\u00e3 s\u1eed d\u1ee5ng opioid tr\u01b0\u1edbc \u0111\u00f3.<\/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 gi\u1ea3m \u0111au sau ph\u1eabu thu\u1eadt tim h\u1edf.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Gi\u1ea3m \u0111au sau ph\u1eabu thu\u1eadt tim h\u1edf l\u00e0 y\u1ebfu t\u1ed1 gi\u00fap c\u1ea3i thi\u1ec7n sau ph\u1eabu thu\u1eadt. Vi\u1ec7c ki\u1ec3m so\u00e1t \u0111au l\u00e0m gi\u1ea3m ph\u1ea3n \u1ee9ng th\u1ea7n kinh giao c\u1ea3m, l\u00e0m gi\u1ea3m nguy c\u01a1 thi\u1ebfu m\u00e1u c\u01a1 tim v\u00e0 nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p, t\u00e2m l\u00fd t\u1ed5ng th\u1ec3 v\u00e0 ph\u1ee5c h\u1ed3i [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":2841,"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>Gi\u1ea3m \u0111au sau h\u1eadu ph\u1eabu ph\u1eabu thu\u1eadt tim h\u1edf - Vinmec<\/title>\n<meta name=\"description\" content=\"Gi\u1ea3m \u0111au sau h\u1eadu ph\u1eabu ph\u1eabu thu\u1eadt tim h\u1edf \u0111\u01b0\u1ee3c quan t\u00e2m. 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