{"id":2868,"date":"2023-04-10T19:08:44","date_gmt":"2023-04-10T12:08:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2868"},"modified":"2023-04-17T16:38:59","modified_gmt":"2023-04-17T09:38:59","slug":"nguyen-nhan-chay-mau-trung-that-sau-phau-thuat-tim-ho","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/nguyen-nhan-chay-mau-trung-that-sau-phau-thuat-tim-ho\/","title":{"rendered":"Nguy\u00ean nh\u00e2n ch\u1ea3y m\u00e1u trung th\u1ea5t sau ph\u1eabu thu\u1eadt tim h\u1edf"},"content":{"rendered":"<p><strong>Ch\u1ea3y m\u00e1u trung th\u1ea5t l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng ph\u1ed5 bi\u1ebfn sau ph\u1eabu thu\u1eadt tim h\u1edf. Theo American College of Cardiology, ph\u01b0\u01a1ng ph\u00e1p qu\u1ea3n l\u00fd ch\u1ea3y m\u00e1u trung th\u1ea5t bao g\u1ed3m \u1ed5n \u0111\u1ecbnh ch\u1ee9c n\u0103ng tim, ki\u1ec3m so\u00e1t c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u, s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p ng\u1eebng ch\u1ea3y m\u00e1u trung th\u1ea5t v\u00e0 \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c l\u01b0\u1ee3ng m\u00e1u b\u1ecb m\u1ea5t.<\/strong><\/p>\n<h2><strong>1.Nguy\u00ean nh\u00e2n t\u1eeb ph\u1eabu thu\u1eadt.<\/strong><\/h2>\n<p>S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a b\u1ec7nh l\u00fd van tim, ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3 (BMI) &gt;25 v\u00e0 \u0111\u1ed9 tu\u1ed5i &gt;75 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1. Ngo\u00e0i vi\u1ec7c ng\u01b0ng d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u ho\u1eb7c ch\u1ea5t \u1ee9c ch\u1ebf \u0111\u00f4ng m\u00e1u tr\u01b0\u1edbc ph\u1eabu thu\u1eadt, h\u1ea7u h\u1ebft c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00f4ng th\u1ec3 thay \u0111\u1ed5i.<\/p>\n<p>C\u00e1c ngu\u1ed3n g\u00e2y ch\u1ea3y m\u00e1u ph\u1eabu thu\u1eadt th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn:<\/p>\n<ul>\n<li>V\u1ecb tr\u00ed n\u1ed1i \u1ed1ng (\u0111\u01b0\u1eddng ch\u1ec9 kh\u00e2u)<\/li>\n<li>C\u00e1c nh\u00e1nh b\u00ean c\u1ee7a \u0111\u01b0\u1eddng m\u1ea1ch \u0111\u1ed9ng ho\u1eb7c t\u0129nh m\u1ea1ch<\/li>\n<li>M\u00f4 m\u1ec1m n\u1eb1m d\u01b0\u1edbi x\u01b0\u01a1ng ng\u1ef1c, v\u1ecb tr\u00ed ch\u1ec9 kh\u00e2u x\u01b0\u01a1ng \u1ee9c&#8230;<\/li>\n<li>B\u1ec1 m\u1eb7t th\u00f4 do ph\u1eabu thu\u1eadt tr\u01b0\u1edbc \u0111\u00f3, vi\u00eam m\u00e0ng ngo\u00e0i tim ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u00f3ng x\u1ea1.<\/li>\n<\/ul>\n<h2><strong>2.Nguy\u00ean nh\u00e2n tr\u01b0\u1edbc \u0111\u00f3 g\u00e2y ch\u1ea3y m\u00e1u trong v\u00e0 sau ph\u1eabu thu\u1eadt<\/strong><\/h2>\n<ul>\n<li>Heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng trong ph\u00f2ng m\u1ed5.<\/li>\n<li>Heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p(LMWH) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong v\u00f2ng 18 gi\u1edd .<\/li>\n<li>Thu\u1ed1c kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng th\u1ebf h\u1ec7 m\u1edbi(NOAC), bao g\u1ed3m Dabigatran, apixaban, rivaroxaban v\u00e0 edoxaban khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong v\u00f2ng 48 gi\u1edd ho\u1eb7c th\u1eadm ch\u00ed l\u00e2u h\u01a1n \u1edf b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh m\u00e3n t\u00ednh.<\/li>\n<li>Ch\u1ea5t \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp c\u1ee7a thrombin t\u0129nh m\u1ea1ch (bivalirudin)<\/li>\n<li>Ch\u1ea5t \u1ee9c ch\u1ebf gi\u00e1n ti\u1ebfp c\u1ee7a y\u1ebfu t\u1ed1 Xa (fondaparinux)<\/li>\n<\/ul>\n<p>T\u1ea5t c\u1ea3 \u0111\u1ec1u l\u00e0 nh\u1eefng t\u00e1c nh\u00e2n g\u00e2y ch\u1ea3y m\u00e1u trong v\u00e0 sau ph\u1eabu thu\u1eadt v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u1ed5i ho\u1eb7c ng\u01b0ng s\u1eed d\u1ee5ng tr\u01b0\u1edbc ph\u1eabu thu\u1eadt \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 ch\u1ea3y m\u00e1u. C\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf \u0111\u00f4ng m\u00e1u n\u00e0y c\u00f3 th\u1ec3 c\u00f2n l\u1ea1i trong c\u01a1 th\u1ec3 sau khi ng\u01b0ng s\u1eed d\u1ee5ng v\u00e0 g\u00e2y ra hi\u1ec7u \u1ee9ng ch\u1ea5t \u1ee9c ch\u1ebf \u0111\u00f4ng m\u00e1u c\u00f2n l\u1ea1i, do \u0111\u00f3 ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i v\u00e0 x\u1eed l\u00fd c\u1ea9n th\u1eadn \u0111\u1ec3 tr\u00e1nh t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c.<\/p>\n<h2><strong>3.Nguy\u00ean nh\u00e2n g\u00e2y gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a ti\u1ec3u c\u1ea7u<\/strong><\/h2>\n<p>Ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u tr\u01b0\u1edbc ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng do c\u00e1c thu\u1ed1c ch\u1ed1ng ti\u1ec3u c\u1ea7u (aspirin v\u00e0 c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf P2Y12 [clopidogrel, ticagrelor, prasugrel]), c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf glycoprotein IIb\/IIIa (tirofiban, eptifibatide, abciximab), c\u00e1c lo\u1ea1i th\u1ea3o d\u01b0\u1ee3c v\u00e0 vitamin (d\u1ea7u c\u00e1, s\u1ea3n ph\u1ea9m b\u1ea1ch qu\u1ea3, vitamin E).<\/p>\n<ul>\n<li>Ti\u1ec3u c\u1ea7u ti\u1ebfp x\u00fac v\u1edbi tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3(CPB) k\u00e8m theo vi\u1ec7c gi\u1ea3i ph\u00f3ng alpha-Granules v\u00e0 thay \u0111\u1ed5i c\u00e1c th\u1ee5 th\u1ec3 m\u00e0ng ti\u1ec3u c\u1ea7u g\u00e2y t\u1ed5n th\u01b0\u01a1ng ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u. M\u1ee9c \u0111\u1ed9 \u1ea3nh h\u01b0\u1edfng ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u t\u01b0\u01a1ng quan v\u1edbi th\u1eddi gian s\u1eed d\u1ee5ng CPB v\u00e0 m\u1ee9c \u0111\u1ed9 h\u1ea1 th\u00e2n nhi\u1ec7t.<\/li>\n<li>Kh\u00f4ng \u0111\u1ee7 thu\u1ed1c h\u00f3a gi\u1ea3i heparin l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng th\u1ea5y khi\u1ebfn cho thrombin \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng, k\u00edch ho\u1ea1t.<\/li>\n<\/ul>\n<p>C\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nguy c\u01a1 cao v\u1ec1 ch\u1ea3y m\u00e1u trong v\u00e0 sau ph\u1eabu thu\u1eadt. Vi\u1ec7c s\u1eed d\u1ee5ng ch\u1ea5t \u1ee9c ch\u1ebf ti\u1ec3u c\u1ea7u tr\u01b0\u1edbc ph\u1eabu thu\u1eadt v\u00e0 ti\u1ebfp x\u00fac v\u1edbi CPB l\u00e0 hai nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y t\u1ed5n th\u01b0\u01a1ng ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u. Do \u0111\u00f3, c\u1ea7n ph\u1ea3i theo d\u00f5i v\u00e0 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u k\u1ef9 l\u01b0\u1ee1ng trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt v\u00e0 \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng xu\u1ea5t huy\u1ebft (n\u1ebfu c\u1ea7n thi\u1ebft).<\/p>\n<h2><strong>4.Nguy\u00ean nh\u00e2n t\u1eeb gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng c\u1ee7a ti\u1ec3u c\u1ea7u<\/strong><\/h2>\n<ul>\n<li>Gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u tr\u01b0\u1edbc ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n do s\u1eed d\u1ee5ng heparin, ph\u1ea3n \u1ee9ng thu\u1ed1c (ch\u1ea5t \u1ee9c ch\u1ebf P2Y12 bao g\u1ed3m clopidogrel v\u00e0 prasugrel, nh\u01b0ng kh\u00f4ng ph\u1ea3i ticagrelor, kh\u00e1ng sinh v\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf IIb\/IIIa), nhi\u1ec5m tr\u00f9ng v\u00e0 nh\u1eefng t\u00ecnh tr\u1ea1ng m\u1ea1n t\u00ednh kh\u00e1c. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 gi\u1ea3m ti\u1ec3u c\u1ea7u sau khi s\u1eed d\u1ee5ng heparin g\u1ea7n \u0111\u00e2y, c\u1ea7n ph\u1ea3i lo\u1ea1i tr\u1eeb vi\u1ec7c gi\u1ea3m ti\u1ec3u c\u1ea7u do t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a heparin (HIT).<\/li>\n<li>S\u1ef1 ph\u00e2n t\u00e1n m\u00e1u tr\u00ean m\u00e1y tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3(CPB)\u00a0 c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u kho\u1ea3ng 30-50% v\u00e0 t\u00ecnh tr\u1ea1ng gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u s\u1ebd ti\u1ebfn tri\u1ec3n khi th\u1eddi gian s\u1eed d\u1ee5ng CPB k\u00e9o d\u00e0i.<\/li>\n<li>Vi\u1ec7c s\u1eed d\u1ee5ng protamine t\u1ea1m th\u1eddi l\u00e0m gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u kho\u1ea3ng 30%.<\/li>\n<\/ul>\n<h2><strong>5.Nguy\u00ean nh\u00e2n do s\u1eed d\u1ee5ng heparin v\u00e0 protamine trong ph\u1eabu thu\u1eadt<\/strong><\/h2>\n<p>Hi\u1ec7u \u1ee9ng heparin c\u00f2n l\u1ea1i c\u00f3 th\u1ec3 x\u1ea3y ra do s\u1eed d\u1ee5ng protamine kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 trung ho\u00e0 heparin v\u00e0o cu\u1ed1i qu\u00e1 tr\u00ecnh s\u1eed d\u1ee5ng CPB. Vi\u1ec7c s\u1eed d\u1ee5ng m\u00e1u &#8220;b\u01a1m&#8221; ho\u00e0n to\u00e0n \u0111\u01b0\u1ee3c heparin h\u00f3a v\u00e0o cu\u1ed1i qu\u00e1 tr\u00ecnh ti\u00eam protamine s\u1ebd l\u00e0m heparin ch\u01b0a \u0111\u01b0\u1ee3c trung ho\u00e0 v\u00e0o CPB, g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u.<\/p>\n<h2><strong>6.Nguy\u00ean nh\u00e2n g\u00e2y thi\u1ebfu h\u1ee5t c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u<\/strong><\/h2>\n<ul>\n<li>Ch\u1ee9c n\u0103ng gan tr\u01b0\u1edbc ph\u1eabu thu\u1eadt b\u1ea5t th\u01b0\u1eddng, hi\u1ec7u \u1ee9ng c\u00f2n l\u1ea1i c\u1ee7a warfarin v\u1edbi thi\u1ebfu h\u1ee5t c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u ph\u1ee5 thu\u1ed9c v\u00e0o vitamin K. Ch\u1ea3y m\u00e1u t\u0103ng c\u1ee5 th\u1ec3 c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 fibrinogen th\u1ea5p.<\/li>\n<li>B\u1ec7nh Von Willebrand do thi\u1ebfu h\u1ee5t y\u1ebfu t\u1ed1 Von Willebrand, m\u1ed9t protein \u0111\u00f4ng m\u00e1u k\u1ebft h\u1ee3p v\u1edbi y\u1ebfu t\u1ed1 VIII v\u00e0 ti\u1ec3u c\u1ea7u \u0111\u1ec3 t\u1ea1o th\u00e0nh kh\u1ed1i m\u00e1u \u0111\u00f4ng.<\/li>\n<li>S\u1ef1 ph\u00e2n t\u00e1n m\u00e1u tr\u00ean CPB gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng h\u1ea7u h\u1ebft c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u kho\u1ea3ng 50%, bao g\u1ed3m fibrinogen.<\/li>\n<li>S\u1eed d\u1ee5ng c\u00e1c t\u00fai gi\u1eef m\u00e1u( c\u00f3 c\u00e1c ch\u1ea5t ch\u1ed1ng \u0111\u00f4ng) trong ph\u1eabu thu\u1eadt g\u00e2y m\u1ea5t y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u.<\/li>\n<\/ul>\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 v\u1ec1 h\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ch\u1ea3y m\u00e1u trung th\u1ea5t l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng ph\u1ed5 bi\u1ebfn sau ph\u1eabu thu\u1eadt tim h\u1edf. Theo American College of Cardiology, ph\u01b0\u01a1ng ph\u00e1p qu\u1ea3n l\u00fd ch\u1ea3y m\u00e1u trung th\u1ea5t bao g\u1ed3m \u1ed5n \u0111\u1ecbnh ch\u1ee9c n\u0103ng tim, ki\u1ec3m so\u00e1t c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u, s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p ng\u1eebng ch\u1ea3y m\u00e1u trung th\u1ea5t v\u00e0 \u0111\u00e1nh gi\u00e1 [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":17852,"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>Nguy\u00ean nh\u00e2n ch\u1ea3y m\u00e1u trung th\u1ea5t sau ph\u1eabu thu\u1eadt tim h\u1edf - Vinmec<\/title>\n<meta name=\"description\" content=\"Ch\u1ea3y m\u00e1u trung th\u1ea5t sau ph\u1eabu thu\u1eadt tim h\u1edf l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m. 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