{"id":2725,"date":"2023-04-10T19:10:33","date_gmt":"2023-04-10T12:10:33","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2725"},"modified":"2023-04-19T14:59:59","modified_gmt":"2023-04-19T07:59:59","slug":"kiem-soat-giai-doan-hau-phau-som-tren-benh-nhan-phau-thuat-tim-ho","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/kiem-soat-giai-doan-hau-phau-som-tren-benh-nhan-phau-thuat-tim-ho\/","title":{"rendered":"Ki\u1ec3m so\u00e1t giai \u0111o\u1ea1n h\u1eadu ph\u1eabu s\u1edbm tr\u00ean b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim h\u1edf"},"content":{"rendered":"<p><strong>Ki\u1ec3m so\u00e1t h\u1eadu ph\u1eabu g\u1ed3m ki\u1ec3m so\u00e1t th\u00e2n nhi\u1ec7t v\u00e0 ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 quan tr\u1ecdng trong giai \u0111o\u1ea1n\u00a0 s\u1edbm tr\u00ean b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim h\u1edf. Giai \u0111o\u1ea1n n\u00e0y \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 \u1ed5n \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n v\u00e0 gi\u1ea3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng.<\/strong><\/p>\n<h2><strong>1.T\u1ea7m quan tr\u1ecdng c\u1ee7a ki\u1ec3m so\u00e1t th\u00e2n nhi\u1ec7t<\/strong><\/h2>\n<ul>\n<li>Nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 \u00edt nh\u1ea5t l\u00e0 36,5 \u00b0C. M\u1eb7c d\u00f9 l\u00e0m n\u00f3ng c\u01a1 th\u1ec3 b\u1ec7nh nh\u00e2n \u0111\u1ebfn 37 \u00b0C tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng m\u00e1y l\u00e0m \u1ea5m m\u00e1u th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n, c\u00f3 th\u1ec3 g\u00e2y suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ea7n kinh.Nhi\u1ec7t \u0111\u1ed9 c\u1ee7a trung t\u00e2m \u0111i\u1ec1u nhi\u1ec7t cao h\u01a1n v\u00e0i \u0111\u1ed9 so v\u1edbi nhi\u1ec7t \u0111\u1ed9 n\u01a1i kh\u00e1c khi l\u00e0m n\u00f3ng l\u1ea1i c\u01a1 th\u1ec3, cho th\u1ea5y r\u1eb1ng nhi\u1ec7t \u0111\u1ed9 \u0111o \u1edf c\u00e1c v\u1ecb tr\u00ed kh\u00e1c c\u00f3 th\u1ec3 th\u1ea5p h\u01a1n nhi\u1ec7t \u0111\u1ed9 trung t\u00e2m \u0111i\u1ec1u nhi\u1ec7t.<\/li>\n<li>\u1ede ph\u00f2ng ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t, h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ec1u b\u1ecb co m\u1ea1ch ngo\u1ea1i vi nh\u01b0 m\u1ed9t c\u01a1 ch\u1ebf b\u00f9 \u0111\u1eafp l\u00e0m n\u00f3ng c\u01a1 th\u1ec3. Gi\u00e3n m\u1ea1ch b\u1eb1ng thu\u1ed1c nh\u01b0 nitroprusside ho\u1eb7c propofol c\u00f3 th\u1ec3 gi\u00fap ph\u00e2n ph\u1ed1i l\u1ea1i nhi\u1ec7t \u0111\u1ed9 \u0111\u1ebfn c\u00e1c m\u00f4 ngo\u1ea1i vi v\u00e0 c\u1ea3i thi\u1ec7n l\u01b0u th\u00f4ng m\u00f4, nh\u01b0ng \u0111\u1ed3ng th\u1eddi ch\u00fang c\u0169ng c\u00f3 th\u1ec3 l\u00e0m ch\u1eadm s\u1ef1 l\u00e0m n\u00f3ng trung t\u00e2m \u0111i\u1ec1u nhi\u1ec7t v\u00ec gi\u00e3n m\u1ea1ch ngo\u1ea1i vi t\u0103ng th\u00eam s\u1ef1 m\u1ea5t nhi\u1ec7t.<\/li>\n<li>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ki\u1ec3m so\u00e1t th\u00e2n nhi\u1ec7t bao g\u1ed3m s\u1eed d\u1ee5ng h\u1ec7 th\u1ed1ng s\u01b0\u1edfi \u1ea5m, qu\u1ea3n l\u00fd d\u1ecbch truy\u1ec1n v\u00e0 c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au v\u00e0 c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng nhi\u1ec1u l\u1edbp ch\u0103n. H\u1ec7 th\u1ed1ng s\u01b0\u1edfi \u1ea5m bao g\u1ed3m c\u00e1c thi\u1ebft b\u1ecb s\u01b0\u1edfi \u1ea5m nh\u01b0 ch\u0103n, t\u1ea5m s\u01b0\u1edfi v\u00e0 m\u00e1y s\u01b0\u1edfi \u1ea5m. Nh\u1eefng thi\u1ebft b\u1ecb n\u00e0y \u0111\u01b0\u1ee3c \u0111\u1eb7t g\u1ea7n b\u1ec7nh nh\u00e2n \u0111\u1ec3 t\u1ea1o ra m\u1ed9t m\u00f4i tr\u01b0\u1eddng \u1ea5m \u00e1p v\u00e0 gi\u1eef cho c\u01a1 th\u1ec3 b\u1ec7nh nh\u00e2n \u1edf nhi\u1ec7t \u0111\u1ed9 ph\u00f9 h\u1ee3p.Vi\u1ec7c s\u1eed d\u1ee5ng h\u1ec7 th\u1ed1ng s\u01b0\u1edfi \u1ea5m sau ph\u1eabu thu\u1eadt tim c\u00f3 nhi\u1ec1u l\u1ee3i \u00edch. \u0110\u1ea7u ti\u00ean, n\u00f3 gi\u00fap gi\u1eef cho c\u01a1 th\u1ec3 b\u1ec7nh nh\u00e2n \u1edf nhi\u1ec7t \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh, gi\u1ea3m nguy c\u01a1 b\u1ec7nh nh\u00e2n b\u1ecb h\u1ea1 nhi\u1ec7t \u0111\u1ed9. Th\u1ee9 hai, n\u00f3 c\u0169ng gi\u00fap t\u0103ng c\u01b0\u1eddng tu\u1ea7n ho\u00e0n m\u00e1u v\u00e0 gi\u1ea3m nguy\u00a0 c\u01a1 m\u1eafc c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn vi\u1ec7c b\u1ec7nh nh\u00e2n b\u1ecb h\u1ea1 nhi\u1ec7t \u0111\u1ed9, nh\u01b0 suy tim v\u00e0 suy h\u00f4 h\u1ea5p.<\/li>\n<\/ul>\n<h2><strong>2.Ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u trung th\u1ea5t<\/strong><\/h2>\n<ul>\n<li>Nhi\u1ec1u y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 l\u00e0m cho b\u1ec7nh nh\u00e2n d\u1ec5 b\u1ecb ch\u1ea3y m\u00e1u trung th\u1ea5t sau khi s\u1eed d\u1ee5ng tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3 (CPB),bao g\u1ed3m t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a heparin c\u00f2n l\u1ea1i, thi\u1ebfu h\u1ee5t ti\u1ec3u c\u1ea7u v\u00e0 ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u, thi\u1ebfu h\u1ee5t c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u, v\u1ea5n \u0111\u1ec1 k\u1ef9 thu\u1eadt trong ph\u1eabu thu\u1eadt, h\u1ea1 nhi\u1ec7t \u0111\u1ed9 v\u00e0 t\u0103ng huy\u1ebft \u00e1p sau ph\u1eabu thu\u1eadt.<\/li>\n<li>C\u00e1c lo\u1ea1i thu\u1ed1c c\u1ea7m m\u00e1u, bao g\u1ed3m axit \u03b5-aminocaproic v\u00e0 axit tranexamic, \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng trong t\u1ea5t c\u1ea3 c\u00e1c th\u1ee7 thu\u1eadt ph\u1eabu thu\u1eadt tim \u0111\u1ec3 gi\u1ea3m ch\u1ea3y m\u00e1u trong ph\u1eabu thu\u1eadt. Li\u1ec1u l\u01b0\u1ee3ng acid tranexamic s\u1ebd ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 ch\u1ea3y m\u00e1u c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh b\u1edfi b\u00e1c s\u0129. Th\u00f4ng th\u01b0\u1eddng, li\u1ec1u kh\u1edfi \u0111\u1ea7u c\u1ee7a acid tranexamic sau ph\u1eabu thu\u1eadt tim l\u00e0 1 gram ti\u00eam tr\u1ef1c ti\u1ebfp v\u00e0o t\u0129nh m\u1ea1ch trong v\u00f2ng 10 ph\u00fat \u0111\u1ea7u ti\u00ean sau khi ho\u1ea1t \u0111\u1ed9ng k\u1ebft th\u00fac, sau \u0111\u00f3 l\u00e0 1 gram ti\u00eam v\u00e0o t\u0129nh m\u1ea1ch m\u1ed7i 6 gi\u1edd trong v\u00f2ng 24 gi\u1edd sau ph\u1eabu thu\u1eadt. Vi\u1ec7c s\u1eed d\u1ee5ng acid tranexamic \u0111\u1ec3 ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u sau ph\u1eabu thu\u1eadt tim \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n. Tuy nhi\u00ean, nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy th\u1eadn ho\u1eb7c d\u1ecb \u1ee9ng v\u1edbi thu\u1ed1c n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng. Ngo\u00e0i ra, vi\u1ec7c s\u1eed d\u1ee5ng acid tranexamic c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u00fang c\u00e1ch v\u00e0 theo ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 tr\u00e1nh c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00f4ng mong mu\u1ed1n.<\/li>\n<li>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.<\/li>\n<li>C\u00e1c x\u00e9t nghi\u1ec7m \u0111\u00f4ng m\u00e1u th\u00f4ng th\u01b0\u1eddng (INR, PTT, fibrinogen, s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u) c\u0169ng n\u00ean \u0111\u01b0\u1ee3c ph\u00e2n t\u00edch. M\u1eb7c d\u00f9 ch\u00fang th\u01b0\u1eddng c\u00f3 k\u1ebft qu\u1ea3 b\u1ea5t th\u01b0\u1eddng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ea3y m\u00e1u b\u1ea5t th\u01b0\u1eddng, ch\u00fang c\u0169ng c\u00f3 th\u1ec3 b\u1ea5t th\u01b0\u1eddng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ea3y m\u00e1u do ph\u1eabu thu\u1eadt.\u00a0N\u1ebfu s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u d\u01b0\u1edbi 100.000\/\u03bcL, c\u1ea7n ph\u1ea3i truy\u1ec1n ti\u1ec3u c\u1ea7u cho b\u1ec7nh nh\u00e2n \u0111ang ch\u1ea3y m\u00e1u. H\u01a1n n\u1eefa, v\u00ec ti\u1ec3u c\u1ea7u gi\u1ea3m ch\u1ee9c n\u0103ng \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng tr\u01b0\u1edbc ph\u1eabu thu\u1eadt v\u00e0 sau khi th\u1ef1c hi\u1ec7n tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3(CPB), c\u1ea7n ph\u1ea3i c\u00e2n nh\u1eafc truy\u1ec1n ti\u1ec3u c\u1ea7u \u0111\u1ec3 ng\u0103n ch\u1eb7n ch\u1ea3y m\u00e1u ti\u1ebfp di\u1ec5n, ngay c\u1ea3 khi s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u v\u01b0\u1ee3t qu\u00e1 100.000\/\u03bcL.Kh\u00f4ng c\u1ea7n ph\u1ea3i truy\u1ec1n ti\u1ec3u c\u1ea7u cho b\u1ec7nh nh\u00e2n kh\u00f4ng ch\u1ea3y m\u00e1u tr\u1eeb khi s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u qu\u00e1 th\u1ea5p \u0111\u1ebfn m\u1ee9c nguy hi\u1ec3m (&lt;20-30,000\/\u03bcL).<\/li>\n<\/ul>\n<h2><strong>3.K\u1ebft lu\u1eadn<\/strong><\/h2>\n<p>Trong ph\u1eabu thu\u1eadt tim h\u1edf, ki\u1ec3m so\u00e1t th\u00e2n nhi\u1ec7t v\u00e0 ch\u1ea3y m\u00e1u trung th\u1ea5t l\u00e0 hai v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng. Ki\u1ec3m so\u00e1t th\u00e2n nhi\u1ec7t b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng h\u1ec7 th\u1ed1ng s\u01b0\u1edfi, ch\u0103n \u1ea5m v\u00e0 thu\u1ed1c gi\u1ea3m \u0111au c\u00f3 th\u1ec3 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng n\u00e3o v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng kh\u00e1c. Tuy nhi\u00ean, vi\u1ec7c ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u trung th\u1ea5t l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c l\u1edbn. Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c s\u1ea3n ph\u1ea9m m\u00e1u c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m nguy c\u01a1 t\u1eed vong. Tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng qu\u00e1 nhi\u1ec1u s\u1ea3n ph\u1ea9m m\u00e1u c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u v\u00e0 nhi\u1ec5m tr\u00f9ng. Do \u0111\u00f3, ti\u1ebfp c\u1eadn ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u trung th\u1ea5t trong ph\u1eabu thu\u1eadt tim h\u1edf n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc k\u1ef9 l\u01b0\u1ee1ng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o t\u1ed1i \u01b0u h\u00f3a k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n.<\/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 c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch. \u0111\u1eb7c bi\u1ec7t l\u00e0 ph\u1eabu thu\u1eadt tim.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ki\u1ec3m so\u00e1t h\u1eadu ph\u1eabu g\u1ed3m ki\u1ec3m so\u00e1t th\u00e2n nhi\u1ec7t v\u00e0 ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 quan tr\u1ecdng trong giai \u0111o\u1ea1n\u00a0 s\u1edbm tr\u00ean b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim h\u1edf. Giai \u0111o\u1ea1n n\u00e0y \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 \u1ed5n \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n v\u00e0 gi\u1ea3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng. 1.T\u1ea7m quan [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":20127,"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>Ki\u1ec3m so\u00e1t h\u1eadu ph\u1eabu s\u1edbm tr\u00ean b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim h\u1edf<\/title>\n<meta name=\"description\" content=\"Ki\u1ec3m so\u00e1t giai \u0111o\u1ea1n h\u1eadu ph\u1eabu s\u1edbm tr\u00ean b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim h\u1edf l\u00e0 v\u1ea5n \u0111\u1ec1 quan t\u00e2m hi\u1ec7n nay. 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