{"id":28771,"date":"2023-05-06T20:11:29","date_gmt":"2023-05-06T13:11:29","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28771"},"modified":"2023-05-06T20:11:29","modified_gmt":"2023-05-06T13:11:29","slug":"soc-tim-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/soc-tim-o-tre-em\/","title":{"rendered":"S\u1ed1c tim \u1edf tr\u1ebb em"},"content":{"rendered":"

S\u1ed1c tim \u1edf tr\u1ebb em l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng nguy hi\u1ec3m v\u00e0 kh\u1ea9n c\u1ea5p, \u0111\u00e2y l\u00e0 t\u00ecnh tr\u1ea1ng m\u00e0 tim suy gi\u1ea3m kh\u1ea3 n\u0103ng b\u01a1m m\u00e1u \u0111\u1ebfn c\u00e1c b\u1ed9 ph\u1eadn c\u1ee7a c\u01a1 th\u1ec3 \u0111\u1ec3 duy tr\u00ec s\u1ef1 s\u1ed1ng. S\u1ed1c tim \u1edf tr\u1ebb em c\u00f3 th\u1ec3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau. Khi kh\u00f4ng \u0111\u01b0\u1ee3c x\u1eed l\u00fd k\u1ecbp th\u1eddi, s\u1ed1c tim \u1edf tr\u1ebb em c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng v\u00e0 th\u1eadm ch\u00ed g\u00e2y t\u1eed vong<\/strong><\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng s\u1ed1c tim:<\/h2>\n

S\u1ed1c tim l\u00e0 t\u00ecnh tr\u1ea1ng m\u1ea5t ch\u1ee9c n\u0103ng co b\u00f3p c\u1ee7a c\u01a1 tim, d\u1eabn \u0111\u1ebfn h\u1ec7 th\u1ed1ng tu\u1ea7n ho\u00e0n kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 \u0111\u00e1p \u1ee9ng nhu c\u1ea7u chuy\u1ec3n h\u00f3a c\u1ee7a c\u01a1 th\u1ec3 v\u00e0 c\u00e1c c\u01a1 quan b\u00ean trong.<\/p>\n

S\u1ed1c tim \u0111\u01b0\u1ee3c x\u1ebfp h\u1ea1ng th\u1ee9 ba trong s\u1ed1 c\u00e1c lo\u1ea1i s\u1ed1c, sau s\u1ed1c nhi\u1ec5m khu\u1ea9n v\u00e0 s\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n. Tuy nhi\u00ean, s\u1ed1 l\u01b0\u1ee3ng tr\u1ebb em m\u1eafc s\u1ed1c tim \u00edt h\u01a1n so v\u1edbi ng\u01b0\u1eddi l\u1edbn.<\/p>\n

\"S\u1ed1c
S\u1ed1c tim \u1edf tr\u1ebb em<\/figcaption><\/figure>\n

2. Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n:<\/h2>\n

Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a s\u1ed1c tim l\u00e0 gi\u1ea3m cung l\u01b0\u1ee3ng tim, gi\u1ea3m t\u01b0\u1edbi m\u00e1u t\u1ed5 ch\u1ee9c trong khi th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n th\u00edch h\u1ee3p.<\/p>\n

2.1. L\u00e2m s\u00e0ng<\/h3>\n
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Nh\u1ecbp tim nhanh l\u00e0 m\u1ed9t trong nh\u1eefng d\u1ea5u hi\u1ec7u s\u1edbm th\u01b0\u1eddng g\u1eb7p trong s\u1ed1c, tuy nhi\u00ean kh\u00f4ng mang t\u00ednh \u0111\u1eb7c hi\u1ec7u. Tri\u1ec7u ch\u1ee9ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u bao g\u1ed3m thi\u1ec3u ni\u1ec7u (<1ml\/kg\/gi\u1edd), ch\u00eanh l\u1ec7ch nhi\u1ec7t \u0111\u1ed9 da v\u00e0 nhi\u1ec7t \u0111\u1ed9 trung t\u00e2m, suy gi\u1ea3m \u00fd th\u1ee9c v\u00e0 gi\u1ea3m t\u01b0\u1edbi m\u00e1u ngo\u1ea1i bi\u00ean v\u1edbi da v\u00e0 \u0111\u1ea7u chi t\u00e1i, v\u00e2n t\u00edm, l\u1ea1nh v\u00e0 \u1ea9m, th\u1eddi gian l\u00e0m \u0111\u1ea7y mao m\u1ea1ch k\u00e9o d\u00e0i (refill > 2 gi\u00e2y).<\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng th\u1edf nhanh, nh\u1ecbp tim b\u1ea5t th\u01b0\u1eddng nh\u01b0 nh\u1ecbp ba ho\u1eb7c nh\u1ecbp ng\u1ef1a phi, kh\u00f2 kh\u00e8 ho\u1eb7c rales \u1ea9m, kh\u00f3 th\u1edf ho\u1eb7c ho, t\u00edm t\u00e1i, v\u00e3 m\u1ed3 h\u00f4i, gan to, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i v\u00e0 ph\u00f9 ngo\u1ea1i vi c\u0169ng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n. H\u1ea1 huy\u1ebft \u00e1p l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u mu\u1ed9n v\u00e0 r\u1ea5t nghi\u00eam tr\u1ecdng.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

<\/section>\n

2.2. C\u1eadn l\u00e2m s\u00e0ng<\/h3>\n

– C\u00f4ng th\u1ee9c m\u00e1u: s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u, h\u1ed3ng c\u1ea7u, Hb v\u00e0 ti\u1ec3u c\u1ea7u.<\/p>\n

– X\u00e9t nghi\u1ec7m men tim: B – type natriuretic protein (BNP), NT – proBNP, protonin T va I, CK-MB<\/p>\n

– \u0110i\u1ec7n gi\u1ea3i \u0111\u1ed3, can xi, ma gi\u00ea, BUN, creatinin, ch\u1ee9c n\u0103ng gan. Lactate v\u00e0 kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch. \u0110o \u0111\u1ed9 b\u00e3o h\u00f2a oxy m\u00e1u t\u0129nh m\u1ea1ch pha tr\u1ed9n ho\u1eb7c t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean (ScvO2) \u01b0\u1edbc l\u01b0\u1ee3ng hi\u1ec7u qu\u1ea3 c\u1ee7a s\u1ef1 cung c\u1ea5p oxy d\u1ef1a tr\u00ean nguy\u00ean t\u1eafc Fick .<\/p>\n

– X quang ph\u1ed5i: c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n tim to v\u00e0 xung huy\u1ebft ph\u1ed5i, ch\u1ec9 s\u1ed1 tim ng\u1ef1c t\u0103ng (ch\u1ec9 s\u1ed1 tim ng\u1ef1c b\u00ecnh th\u01b0\u1eddng < 55% \u1edf tr\u1ebb nh\u0169 nhi v\u00e0 < 50% \u1edf tr\u1ebb l\u1edbn).<\/p>\n

– \u0110i\u1ec7n t\u00e2m \u0111\u1ed3 (ECG) c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n r\u1ed1i lo\u1ea1n nhip tim , t\u00e2m th\u1ea5t ph\u00ec \u0111\u1ea1i, thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9.<\/p>\n

– Si\u00eau \u00e2m tim \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u1ea5u tr\u00fac v\u00e0 ch\u1ee9c n\u0103ng t\u00e2m thu. X\u00e1c \u0111\u1ecbnh ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u (EF) th\u01b0\u1eddng gi\u1ea3m, v\u1eadn \u0111\u1ed9ng th\u00e0nh, k\u00edch th\u01b0\u1edbc th\u1ea5t, \u0111\u1ed9 d\u00e0y th\u00e0nh tim, tr\u00e0o ng\u01b0\u1ee3c van.<\/p>\n

– C\u00e1c x\u00e9t nghi\u00eam kh\u00e1c \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n: x\u00e9t nghi\u1ec7m virus n\u1ebfu nghi vi\u00eam c\u01a1 tim do virus (adeno, coxsackie), hormone tuy\u1ebfn gi\u00e1p n\u1ebfu do c\u01b0\u1eddng gi\u00e1p, catecholamin do u t\u1ee7y th\u01b0\u1ee3ng th\u1eadn, b\u1ec7nh h\u1ec7 th\u1ed1ng, x\u00e9t nghi\u1ec7m \u0111\u1ed9c ch\u1ea5t n\u1ebfu do nhi\u1ec5m \u0111\u1ed9c.<\/p>\n

2.3. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/h3>\n

– L\u00e2m s\u00e0ng c\u00f3 t\u00ecnh tr\u1ea1ng s\u1ed1c v\u00e0 suy tim c\u1ea5p.<\/p>\n

– X quang ph\u1ed5i c\u00f3 di\u1ec7n tim to, \u1ee9 huy\u1ebft ph\u1ed5i.<\/p>\n

– Si\u00eau \u00e2m tim c\u00f3 ch\u1ee9c n\u0103ng co b\u00f3p c\u01a1 tim (EF gi\u1ea3m)<\/p>\n

– X\u00e9t nghi\u1ec7m men tim t\u0103ng cao.<\/p>\n

2.4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h3>\n

– S\u1ed1c nhi\u1ec5m khu\u1ea9n : b\u1ec7nh nhi c\u00f3 h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng, c\u00f3 nhi\u1ec5m khu\u1ea9n n\u1eb7ng\u00a0tuy nhi\u00ean kh\u00f3 ph\u00e2n bi\u1ec7t n\u1ebfu s\u1ed1c nhi\u1ec5m khu\u1ea9n c\u00f3 vi\u00eam c\u01a1 tim.<\/p>\n

– S\u1ed1c giam th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n : b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc ho\u1eb7c m\u1ea5t m\u00e1u, CVP gi\u1ea3m, \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi b\u00f9 d\u1ecbch.<\/p>\n

2.5. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n s\u1ed1c tim<\/h3>\n

S\u1ed1c tim c\u00f3 th\u1ec3 do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau. C\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m:<\/p>\n

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  • Tim b\u1ea9m sinh: \u0111\u00e2y l\u00e0 nh\u00f3m ch\u00ednh g\u00e2y s\u1ed1c tim, th\u01b0\u1eddng do t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i ho\u1eb7c do tim b\u1ea9m sinh c\u00f3 lu\u1ed3ng th\u00f4ng tr\u00e1i-ph\u1ea3i l\u1edbn.<\/li>\n
  • Vi\u00eam tim: nguy\u00ean nh\u00e2n n\u00e0y c\u00f3 th\u1ec3 do nhi\u1ec5m tr\u00f9ng, b\u1ec7nh m\u00f4 li\u00ean k\u1ebft, ng\u1ed9 \u0111\u1ed9c ho\u1eb7c b\u1ec7nh t\u1ef1 mi\u1ec5n. Vi r\u00fat l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t, v\u1edbi coxsackie B v\u00e0 adenovirus l\u00e0 nh\u1eefng lo\u1ea1i vi r\u00fat th\u01b0\u1eddng g\u1eb7p.<\/li>\n
  • B\u1ec7nh c\u01a1 tim: bao g\u1ed3m b\u1ec7nh c\u01a1 tim gi\u00e3n v\u00e0 b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i. Nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 l\u00e0 do di truy\u1ec1n ho\u1eb7c sau nhi\u1ec5m virus va vi\u00eam c\u01a1 tim.<\/li>\n
  • R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a: suy hay c\u01b0\u1eddng c\u1eadn gi\u00e1p tr\u1ea1ng, h\u1ea1 \u0111\u01b0\u1eddng m\u00e1u, v\u00e0 ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c nh\u01b0 sulfonamide, penicillin, anthracyclines.<\/li>\n
  • B\u1ec7nh m\u00f4 li\u00ean k\u1ebft: lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, vi\u00eam kh\u1edbp thanh thi\u1ebfu ni\u00ean, Kawasaki, th\u1ea5p kh\u1edbp c\u1ea5p.<\/li>\n
  • R\u1ed1i lo\u1ea1n nh\u1ecbp tim: bao g\u1ed3m c\u01a1n nh\u1ecbp nhanh k\u1ecbch ph\u00e1t tr\u00ean th\u1ea5t, nh\u1ecbp ch\u1eadm, block tim ho\u00e0n to\u00e0n, nh\u1ecbp nhanh th\u1ea5t ho\u1eb7c rung th\u1ea5t.<\/li>\n
  • T\u1eafc ngh\u1ebdn tim: bao g\u1ed3m tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i hai b\u00ean, tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim c\u1ea5p, t\u1eafc m\u1ea1ch ph\u1ed5i c\u1ea5p n\u1eb7ng.<\/li>\n<\/ul>\n

    Ngo\u00e0i ra, c\u00e1c r\u1ed1i lo\u1ea1n kh\u00e1c nh\u01b0 ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c \u0111\u1ee5ng d\u1eadp tim c\u0169ng c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim v\u00e0 d\u1eabn \u0111\u1ebfn s\u1ed1c tim.<\/p>\n

    3. \u0110i\u1ec1u tr\u1ecb s\u1ed1c tim:<\/h2>\n

    3.1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb:<\/h3>\n

    – Gi\u1ea3m t\u1ed1i thi\u1ec3u nhu c\u1ea7u oxy c\u1ee7a c\u01a1 tim: ki\u1ec3m so\u00e1t h\u00f4 h\u1ea5p, th\u00e2n nhi\u1ec7t,thu\u1ed1c an th\u1ea7n, gi\u00e3n c\u01a1.<\/p>\n

    – H\u1ed7 tr\u1ee3 t\u1ed1i \u0111a ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u01a1 tim: \u0111i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n nh\u1ecbp tim, t\u1ed1i \u01b0u h\u00f3a ti\u1ec1n g\u00e1nh, c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng co b\u00f3p c\u01a1 tim, gi\u1ea3m h\u1eadu g\u00e1nh.<\/p>\n

    – \u0110i\u1ec1u tr\u1ecb c\u0103n nguy\u00ean.<\/p>\n

    3.2. \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u:<\/h3>\n

    Trong giai \u0111o\u1ea1n c\u1ea5p c\u1ee9u ban \u0111\u1ea7u, \u0111i\u1ec1u tr\u1ecb s\u1ed1c tim c\u1ea7n tu\u00e2n theo nguy\u00ean t\u1eafc ABCs (c\u1ea5p c\u1ee9u c\u01a1 b\u1ea3n):<\/p>\n

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    • Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng th\u1edf b\u1eb1ng c\u00e1ch cung c\u1ea5p oxy l\u01b0u l\u01b0\u1ee3ng cao ho\u1eb7c th\u00f4ng kh\u00ed h\u00f4 tr\u1ee3. C\u1ea7n duy tr\u00ec b\u00e3o h\u00f2a oxy m\u00e1u \u0111\u1ed9ng m\u1ea1ch \u2265 95%.<\/li>\n
    • \u0110\u1eb7t huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch x\u00e2m nh\u1eadp v\u00e0 catheter t\u0129nh m\u1ea1ch trung t\u00e2m \u0111\u1ec3 theo d\u00f5i li\u00ean t\u1ee5c c\u00e1c ch\u1ec9 s\u1ed1 SpO2, CVP v\u00e0 huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch.<\/li>\n
    • Ki\u1ec3m so\u00e1t th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n b\u1eb1ng c\u00e1ch b\u1ed5 sung \u0111\u1ee7 l\u01b0\u1ee3ng dung d\u1ecbch n\u1ebfu CVP th\u1ea5p.<\/li>\n
    • L\u1ef1a ch\u1ecdn lo\u1ea1i d\u1ecbch s\u1eed d\u1ee5ng, bao g\u1ed3m d\u1ecbch tinh th\u1ec3 Ringer lactate ho\u1eb7c natriclorua 0,9%, dung d\u1ecbch keo, huy\u1ebft t\u01b0\u01a1ng v\u00e0 m\u00e1u to\u00e0n ph\u1ea7n. Li\u1ec1u truy\u1ec1n l\u00e0 5 ml\/kg\/20 ph\u00fat v\u00e0 c\u00f3 th\u1ec3 nh\u1eafc l\u1ea1i. N\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i d\u1ecbch, c\u1ea7n ng\u01b0ng truy\u1ec1n d\u1ecbch ngay l\u1eadp t\u1ee9c.<\/li>\n
    • C\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd c\u00e1c d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i d\u1ecbch nh\u01b0 gan to, kh\u00f3 th\u1edf, nh\u1ecbp tim nhanh, nh\u1ecbp ng\u1ef1a phi \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh li\u1ec7u ph\u00e1p k\u1ecbp th\u1eddi.<\/li>\n<\/ul>\n

      3.3. Thu\u1ed1c l\u1ee3i ti\u1ec3u<\/h3>\n

      Cho l\u1ee3i ti\u1ec3u lasix TM , li\u1ec1u 1-2mg\/kg khi c\u00f3 bi\u1ec3u hi\u1ec7n \u1ee9 m\u00e1u v\u00e0 qu\u00e1 t\u1ea3i d\u1ecbch. C\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00e1ng thu\u1ed1c l\u1ee3i ti\u1ec3u.<\/p>\n

      3.4. \u0110i\u1ec1u tr\u1ecb thu\u1ed1c t\u0103ng c\u01b0\u1eddng co b\u00f3p c\u01a1 tim, n\u00e2ng huy\u1ebft \u00e1p<\/h3>\n

      \u0110\u1ec3 t\u0103ng c\u01b0\u1eddng co b\u00f3p c\u01a1 tim v\u00e0 n\u00e2ng huy\u1ebft \u00e1p, c\u00e1c lo\u1ea1i thu\u1ed1c sau c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng:<\/p>\n

        \n
      • Thu\u1ed1c tr\u1ee3 tim: Dobutamine v\u1edbi li\u1ec1u kh\u1edfi \u0111\u1ea7u 5 mcg\/kg\/ph\u00fat, t\u0103ng d\u1ea7n m\u1ed7i 2,5 mcg\/kg m\u1ed7i 15 ph\u00fat. Dopamine c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u 5 mcg\/kg\/ph\u00fat, t\u0103ng d\u1ea7n m\u1ed7i 2,5 mcg\/kg m\u1ed7i 15 ph\u00fat ho\u1eb7c Milrinone v\u1edbi li\u1ec1u kh\u1edfi \u0111\u1ea7u 0,375 mcg\/kg\/ph \u0111\u1ec3 t\u0103ng c\u01b0\u1eddng co b\u00f3p c\u01a1 tim v\u00e0 gi\u00e3n m\u1ea1ch ngo\u1ea1i vi.<\/li>\n
      • Thu\u1ed1c t\u0103ng co b\u00f3p c\u01a1 tim v\u00e0 n\u00e2ng huy\u1ebft \u00e1p: Epinephrine v\u00e0 Noradrenaline v\u1edbi li\u1ec1u kh\u1edfi \u0111\u1ea7u 0,05-1mcg\/kg\/ph\u00fat c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, v\u00e0 c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi Dobutamine ho\u1eb7c Dopamine.<\/li>\n<\/ul>\n

        Ngo\u00e0i ra, c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c c\u00f3 th\u1ec3 bao g\u1ed3m:<\/p>\n

          \n
        • S\u1eed d\u1ee5ng Natribicarbonate khi c\u00e2n b\u1eb1ng pH m\u00e1u <7,20 do toan m\u00e1u n\u1eb7ng; ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft; \u0111i\u1ec1u tr\u1ecb c\u00e1c r\u1ed1i lo\u1ea1n n\u1ed9i m\u00f4i bao g\u1ed3m \u0111i\u1ec7n gi\u1ea3i, huy\u1ebft h\u1ecdc, ch\u1ed1ng nhi\u1ec5m khu\u1ea9n; gi\u1ea3m \u0111au v\u00e0 an th\u1ea7n.<\/li>\n<\/ul>\n

          3.5. \u0110i\u1ec1u tr\u1ecb theo nguy\u00ean nh\u00e2n<\/h3>\n

          \u0110\u1ed1i v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1c tim kh\u00e1c nhau, c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb nh\u01b0 sau:<\/p>\n

            \n
          • Vi\u00eam c\u01a1 tim do virus: s\u1eed d\u1ee5ng Gamaglobulin t\u0129nh m\u1ea1ch (IVIG) v\u1edbi li\u1ec1u 2g\/kg\/48 gi\u1edd.<\/li>\n
          • R\u1ed1i lo\u1ea1n nh\u1ecbp tim: \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ho\u1eb7c s\u1ed1c \u0111i\u1ec7n.<\/li>\n
          • S\u1eed d\u1ee5ng l\u1ecdc m\u00e1u li\u00ean t\u1ee5c (CVVH) cho b\u1ec7nh nh\u00e2n s\u1ed1c tim do vi\u00eam c\u01a1 tim ho\u1eb7c b\u1ec7nh nh\u00e2n tay ch\u00e2n mi\u1ec7ng \u0111\u1ed9 IV.<\/li>\n
          • N\u1ebfu c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa kh\u00f4ng \u0111\u00e1p \u1ee9ng k\u00e9m ho\u1eb7c kh\u00f4ng \u0111\u00e1p \u1ee9ng, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng ECMO. Ch\u1ec9 \u0111\u1ecbnh ECMO khi ch\u1ec9 s\u1ed1 v\u1eadn m\u1ea1ch IE (inotropic equivalent) > 40\u00b5g\/kg\/ph. C\u00f4ng th\u1ee9c t\u00ednh IE = (Dopamin + Dobutamin + 100 x Norephineprin + 100 x ephineprin + 15 x milrinon +100 x Isoprotenolol).<\/li>\n
          • H\u1ed9i ch\u1ea9n v\u1edbi chuy\u00ean khoa tim m\u1ea1ch \u0111\u1ec3 ph\u1eabu thu\u1eadt ho\u1eb7c can thi\u1ec7p s\u1eeda ch\u1eefa c\u00e1c d\u1ecb t\u1eadt tim m\u1ea1ch khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/li>\n
          • \u0110i\u1ec1u tr\u1ecb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n<\/ul>\n

            Ngu\u1ed3n: T\u1ed5ng h\u1ee3p<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

            S\u1ed1c tim \u1edf tr\u1ebb em l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng nguy hi\u1ec3m v\u00e0 kh\u1ea9n c\u1ea5p, \u0111\u00e2y l\u00e0 t\u00ecnh tr\u1ea1ng m\u00e0 tim suy gi\u1ea3m kh\u1ea3 n\u0103ng b\u01a1m m\u00e1u \u0111\u1ebfn c\u00e1c b\u1ed9 ph\u1eadn c\u1ee7a c\u01a1 th\u1ec3 \u0111\u1ec3 duy tr\u00ec s\u1ef1 s\u1ed1ng. S\u1ed1c tim \u1edf tr\u1ebb em c\u00f3 th\u1ec3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau. Khi […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15],"tags":[],"yoast_head":"\nS\u1ed1c tim \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"S\u1ed1c tim l\u00e0 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m ch\u1ee9c n\u0103ng co b\u00f3p c\u01a1 tim d\u1eabn \u0111\u1ebfn h\u1ec7 th\u1ed1ng tu\u1ea7n ho\u00e0n kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c nhu c\u1ea7u chuy\u1ec3n h\u00f3a c\u1ee7a m\u00f4 v\u00e0 c\u01a1 quan.\" \/>\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=\"S\u1ed1c tim \u1edf tr\u1ebb em - Vinmec\" \/>\n<meta property=\"og:description\" content=\"S\u1ed1c tim l\u00e0 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m ch\u1ee9c n\u0103ng co b\u00f3p c\u01a1 tim d\u1eabn \u0111\u1ebfn h\u1ec7 th\u1ed1ng tu\u1ea7n ho\u00e0n kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c nhu c\u1ea7u chuy\u1ec3n h\u00f3a c\u1ee7a m\u00f4 v\u00e0 c\u01a1 quan.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/soc-tim-o-tre-em\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-06T13:11:29+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/children-heart-disease-non-cardiac-surgery-300x200.jpg\" \/>\n<meta name=\"author\" content=\"Hoang Linh\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Hoang Linh\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/soc-tim-o-tre-em\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/soc-tim-o-tre-em\/\",\"name\":\"S\u1ed1c tim \u1edf tr\u1ebb em - 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