{"id":2943,"date":"2023-04-10T19:37:44","date_gmt":"2023-04-10T12:37:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2943"},"modified":"2023-04-13T16:06:03","modified_gmt":"2023-04-13T09:06:03","slug":"bien-phap-phong-chay-mau-trung-that-sau-phau-thuat-tim-ho","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/bien-phap-phong-chay-mau-trung-that-sau-phau-thuat-tim-ho\/","title":{"rendered":"Ph\u00f2ng ng\u1eeba ch\u1ea3y m\u00e1u trung th\u1ea5t sau ph\u1eabu thu\u1eadt tim h\u1edf"},"content":{"rendered":"

Ph\u00f2ng ng\u1eeba ch\u1ea3y m\u00e1u trung th\u1ea5t l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng sau ph\u1eabu thu\u1eadt tim h\u1edf. Ngo\u00e0i ra, \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt c\u1ee7a h\u1ec7 th\u1ed1ng \u0111\u00f4ng m\u00e1u c\u0169ng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 \u0111\u00f4ng m\u00e1u. Th\u00eam v\u00e0o \u0111\u00f3, c\u00e1c bi\u1ec7n ph\u00e1p b\u1ea3o t\u1ed3n nh\u01b0 s\u1eed d\u1ee5ng thi\u1ebft b\u1ecb gi\u1eef m\u00e1u v\u00e0 gi\u1ea3m thi\u1ec3u s\u1eed d\u1ee5ng m\u00e1u c\u0169ng c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m nguy c\u01a1 ch\u1ea3y m\u00e1u sau ph\u1eabu thu\u1eadt tim h\u1edf.<\/strong><\/p>\n

1. \u0110\u00e1nh gi\u00e1 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt v\u1ec1 h\u1ec7 th\u1ed1ng \u0111\u00f4ng m\u00e1u c\u1ee7a b\u1ec7nh nh\u00e2n:<\/strong><\/h2>\n

N\u00ean bao g\u1ed3m x\u00e9t nghi\u1ec7m th\u1eddi gian Prothrombin (prothrombin time) \u0111\u01b0\u1ee3c \u0111o b\u1eb1ng t\u1ec9 l\u1ec7 chu\u1ea9n h\u00f3a qu\u1ed1c t\u1ebf (INR), th\u1eddi gian ch\u1ea3y m\u00e1u b\u00e1n ph\u1ea7n (partial thromboplastin time – aPTT) v\u00e0 \u0111\u1ebfm s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u. B\u1ea5t k\u1ef3 b\u1ea5t th\u01b0\u1eddng n\u00e0o ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt. Ki\u1ec3m tra ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng ti\u1ec3u c\u1ea7u ph\u1ea3n \u1ee9ng v\u1edbi ch\u1ea5t \u1ee9c ch\u1ebf P2Y12 l\u00e0 h\u1eefu \u00edch trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh khi n\u00e0o r\u1ee7i ro ch\u1ea3y m\u00e1u th\u1ea5p \u0111\u1ebfn m\u1ee9c \u0111\u1ee7 \u0111\u1ec3 ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt kh\u1ea9n c\u1ea5p, nh\u01b0ng kh\u00f4ng ph\u1ea3i c\u1ea5p c\u1ee9u.<\/p>\n

2.Nh\u1eefng y\u1ebfu t\u1ed1 c\u1ea7n xem x\u00e9t \u1edf b\u1ec7nh nh\u00e2n c\u00f3 thi\u1ebfu m\u00e1u tr\u01b0\u1edbc ph\u1eabu thu\u1eadt.<\/strong><\/h2>\n

Thi\u1ebfu m\u00e1u tr\u01b0\u1edbc ph\u1eabu thu\u1eadt li\u00ean quan \u0111\u1ebfn t\u0103ng t\u1ef7 l\u1ec7 b\u1ec7nh t\u1eadt v\u00e0 t\u1eed vong sau ph\u1eabu thu\u1eadt tim, th\u01b0\u1eddng l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh l\u00fd l\u00e2m s\u00e0ng v\u00e0 t\u0103ng nhu c\u1ea7u truy\u1ec1n m\u00e1u. Vi\u1ec7c b\u1ed5 sung s\u1eaft v\u00e0 s\u1eed d\u1ee5ng erythropoietin tr\u01b0\u1edbc ph\u1eabu thu\u1eadt n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u trong ph\u1eabu thu\u1eadt ch\u01b0\u01a1ng tr\u00ecnh.<\/p>\n

S\u1ef1 lo\u00e3ng m\u00e1u trong qu\u00e1 tr\u00ecnh tu\u1ea7n ho\u00e0n ngo\u00e0i c\u01a1 th\u1ec3 (CPB) c\u00f3 th\u1ec3 g\u00e2y ra thi\u1ebfu m\u00e1u n\u1eb7ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 HCT tr\u01b0\u1edbc ph\u1eabu thu\u1eadt th\u1ea5p. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 t\u0103ng nguy c\u01a1 suy th\u1eadn n\u1ebfu HCT trong CPB th\u1ea5p h\u01a1n nhi\u1ec1u so v\u1edbi 21%. M\u1eb7c d\u00f9 truy\u1ec1n m\u00e1u tr\u01b0\u1edbc ph\u1eabu thu\u1eadt cho HCT <26% s\u1ebd gi\u1ea3m nhu c\u1ea7u truy\u1ec1n m\u00e1u trong ph\u1eabu thu\u1eadt, nh\u01b0ng v\u1eabn c\u00f2n tranh c\u00e3i v\u1ec1 l\u1ee3i \u00edch l\u00e2m s\u00e0ng c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n c\u1ea7n nhi\u1ec1u l\u1ea7n truy\u1ec1n m\u00e1u trong ph\u1eabu thu\u1eadt th\u01b0\u1eddng c\u00f3 xu\u1ea5t huy\u1ebft v\u00e0 c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung b\u1eb1ng c\u00e1c th\u00e0nh ph\u1ea7n m\u00e1u.<\/p>\n

3.Gi\u1ea3m ti\u1ec3u c\u1ea7u do heparin g\u00e2y ra (HIT)<\/strong><\/h2>\n

C\u00f3 th\u1ec3 g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng heparin t\u0129nh m\u1ea1ch trong v\u00e0i ng\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt. Do \u0111\u00f3, r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ki\u1ec3m tra l\u1ea1i s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u h\u00e0ng ng\u00e0y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n

4. Ng\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng ti\u1ec3u c\u1ea7u ho\u1eb7c ch\u1ed1ng \u0111\u00f4ng m\u00e1u<\/strong><\/h2>\n

Warfarin n\u00ean \u0111\u01b0\u1ee3c ng\u1eebng s\u1eed d\u1ee5ng 4-5 ng\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt \u0111\u1ec3 cho ph\u00e9p t\u00e1i t\u1ed5ng h\u1ee3p l\u1ea1i c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u ph\u1ee5 thu\u1ed9c v\u00e0o vitamin K v\u00e0 chu\u1ea9n h\u00f3a t\u1ec9 l\u1ec7 (INR).<\/p>\n

a.N\u1ebfu b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1eabu thu\u1eadt kh\u1ea9n c\u1ea5p, vitamin K n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 chu\u1ea9n h\u00f3a t\u1ec9 l\u1ec7 INR. Vi\u1ec7c ti\u00eam t\u0129nh m\u1ea1ch ch\u1eadm 5 mg trong v\u00f2ng 30 ph\u00fat l\u00e0 hi\u1ec7u qu\u1ea3 \u0111\u1ec3 s\u1edbm thay \u0111\u1ed5i t\u1ec9 l\u1ec7 INR, nh\u01b0ng n\u1ebfu ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 ho\u00e3n l\u1ea1i m\u1ed9t ho\u1eb7c hai ng\u00e0y \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng, n\u00ean s\u1eed d\u1ee5ng vitamin K \u0111\u01b0\u1eddng u\u1ed1ng 5 mg l\u00e0 t\u1ed1t h\u01a1n.
\nb.N\u1ebfu c\u1ea7n ph\u1eabu thu\u1eadt kh\u1ea9n c\u1ea5p, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng huy\u1ebft t\u01b0\u01a1ng \u0111\u00f4ng t\u1ea1p t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh (FFP) ho\u1eb7c t\u1ed5 h\u1ee3p prothrombin c\u00f4 \u0111\u1eb7c(PCC). PCC hi\u1ec7u qu\u1ea3 h\u01a1n v\u00e0 nhanh ch\u00f3ng h\u01a1n trong vi\u1ec7c gi\u1ea3m t\u1ec9 l\u1ec7 INR v\u00e0 l\u00e0 s\u1ea3n ph\u1ea9m \u0111\u01b0\u1ee3c \u01b0a th\u00edch.Li\u1ec1u khuy\u1ebfn ngh\u1ecb l\u00e0 25 \u0111\u01a1n v\u1ecb\/kg cho INR t\u0103ng l\u00ean <4; 35 \u0111\u01a1n v\u1ecb\/kg cho INR 4-6 v\u00e0 50 \u0111\u01a1n v\u1ecb\/kg cho INR >6.<\/p>\n

5.T\u00f3m t\u1eaft c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba ch\u1ea3y m\u00e1u trung th\u1ea5t<\/strong><\/h2>\n

Ch\u1ea3y m\u00e1u trung th\u1ea5t sau ph\u1eabu thu\u1eadt tim h\u1edf l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1eed vong ho\u1eb7c ph\u1eabu thu\u1eadt l\u1ea1i do ch\u1ea3y m\u00e1u. Do \u0111\u00f3, c\u1ea7n ph\u1ea3i \u0111\u00e1nh gi\u00e1 k\u1ef9 v\u00e0 \u00e1p d\u1ee5ng bi\u1ec7n ph\u00e1p ph\u00f9 h\u1ee3p \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 ch\u1ea3y m\u00e1u trung th\u1ea5t sau ph\u1eabu thu\u1eadt tim h\u1edf.<\/p>\n

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":"

Ph\u00f2ng ng\u1eeba ch\u1ea3y m\u00e1u trung th\u1ea5t l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 quan tr\u1ecdng sau ph\u1eabu thu\u1eadt tim h\u1edf. Ngo\u00e0i ra, \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt c\u1ee7a h\u1ec7 th\u1ed1ng \u0111\u00f4ng m\u00e1u c\u0169ng l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 \u0111\u00f4ng m\u00e1u. Th\u00eam v\u00e0o \u0111\u00f3, c\u00e1c bi\u1ec7n ph\u00e1p b\u1ea3o t\u1ed3n […]<\/p>\n","protected":false},"author":7,"featured_media":2951,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nPh\u00f2ng ng\u1eeba ch\u1ea3y m\u00e1u trung th\u1ea5t sau ph\u1eabu thu\u1eadt tim h\u1edf<\/title>\n<meta name=\"description\" content=\"Bi\u1ec7n ph\u00e1p ph\u00f2ng ch\u1ea3y m\u00e1u trung th\u1ea5t sau ph\u1eabu thu\u1eadt tim h\u1edf l\u00e0 v\u1ea5n \u0111\u1ec1 c\u1ea7n quan t\u00e2m. Tham kh\u1ea3o b\u00e0i vi\u1ebft v\u1ec1 c\u00e1c c\u00e1ch ph\u00f2ng ch\u1ea3y m\u00e1u trung th\u1ea5t.\" \/>\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=\"Ph\u00f2ng ng\u1eeba ch\u1ea3y m\u00e1u trung th\u1ea5t sau ph\u1eabu thu\u1eadt tim h\u1edf\" \/>\n<meta property=\"og:description\" content=\"Bi\u1ec7n ph\u00e1p ph\u00f2ng ch\u1ea3y m\u00e1u trung th\u1ea5t sau ph\u1eabu thu\u1eadt tim h\u1edf l\u00e0 v\u1ea5n \u0111\u1ec1 c\u1ea7n quan t\u00e2m. 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