{"id":29433,"date":"2023-04-29T22:02:35","date_gmt":"2023-04-29T15:02:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29433"},"modified":"2023-04-29T22:02:35","modified_gmt":"2023-04-29T15:02:35","slug":"phu-phoi-cap-huyet-dong-chan-doan-va-xu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/phu-phoi-cap-huyet-dong-chan-doan-va-xu-tri\/","title":{"rendered":"Ph\u00f9 ph\u1ed5i c\u1ea5p huy\u1ebft \u0111\u1ed9ng: ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed"},"content":{"rendered":"

Ph\u00f9 ph\u1ed5i c\u1ea5p huy\u1ebft \u0111\u1ed9ng l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u kh\u1ea9n tr\u01b0\u01a1ng, n\u1ebfu ph\u00e1t hi\u1ec7n, ch\u1ea9n \u0111o\u00e1n s\u1edbm, can thi\u1ec7p k\u1ecbp th\u1eddi, b\u1ec7nh c\u00f3 kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c nhanh. N\u1ebfu kh\u00f4ng can thi\u1ec7p k\u1ecbp th\u1eddi v\u00e0 \u0111\u00fang, s\u1ebd nhanh ch\u00f3ng d\u1eabn \u0111\u1ebfn suy h\u00f4 h\u1ea5p c\u1ea5p n\u1eb7ng, nguy c\u01a1 t\u1eed vong cao.<\/strong><\/p>\n

1. C\u01a1 ch\u1ebf chung<\/h2>\n

C\u00f3 th\u1ec3 x\u1ea3y ra do ba nh\u00f3m nguy\u00ean nh\u00e2n:<\/p>\n

– T\u0103ng \u00e1p l\u1ef1c mao m\u1ea1ch ph\u1ed5i kh\u00f4ng do suy tim tr\u00e1i nh\u01b0 trong h\u1eb9p hai l\u00e1<\/p>\n

– T\u0103ng \u00e1p l\u1ef1c mao m\u1ea1ch ph\u1ed5i do suy tim tr\u00e1i nh\u01b0 trong t\u0103ng huy\u1ebft \u00e1p, nh\u1ed3i m\u00e1u c\u01a1 tim, suy v\u00e0nh.<\/p>\n

-T\u0103ng th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n c\u1ea5p t\u00ednh nh\u01b0 trong suy th\u1eadn c\u1ea5p, truy\u1ec1n qu\u00e1 nhi\u1ec1u d\u1ecbch<\/p>\n

2. Nguy\u00ean nh\u00e2n ph\u00f9 ph\u1ed5i c\u1ea5p<\/strong><\/h2>\n

– H\u1eb9p hai l\u00e1<\/p>\n

– T\u0103ng huy\u1ebft \u00e1p<\/a><\/p>\n

– Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p<\/p>\n

– \u0110\u1ee3t m\u1ea5t b\u00f9 c\u1ee7a suy tim tr\u00e1i m\u1ea1n t\u00ednh<\/p>\n

– \u01af\u0301 d\u1ecbch c\u1ea5p: truy\u1ec1n d\u1ecbch, suy th\u1eadn c\u1ea5p, m\u1ea1n<\/p>\n

– Nguy\u00ean nh\u00e2n kh\u00e1c: x\u01a1 gan, nh\u1ed3i m\u00e1u ph\u1ed5i, sau h\u00fat kh\u00ed m\u00e0ng ph\u1ed5i…<\/p>\n

3. Ch\u1ea9n \u0111o\u00e1n ph\u00f9 ph\u1ed5i c\u1ea5p<\/strong><\/h2>\n

3.1.L\u00e2m s\u00e0ng
\n<\/strong>
\n– C\u01a1n ph\u00f9 ph\u1ed5i c\u1ea5p th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u0111\u1ed9t ng\u1ed9t, ti\u1ebfn tri\u1ec3n nhanh, hay g\u1eb7p v\u1ec1 \u0111\u00eam.<\/p>\n

– B\u1ec7nh nh\u00e2n lo l\u1eafng, ho\u1ea3ng h\u1ed1t, v\u00e3 m\u1ed3 h\u00f4i<\/p>\n

– Kh\u00f3 th\u1edf, th\u1edf nhanh (tr\u00ean 30 l\u1ea7n ph\u00fat), ph\u1ea3i ng\u1ed3i d\u1eady \u0111\u1ec3 th\u1edf, t\u00edm m\u00f4i v\u00e0 \u0111\u1ea7u chi<\/p>\n

– C\u00f3 th\u1ec3 kh\u1ea1c ra \u0111\u1eddm b\u1ecdt h\u1ed3ng<\/p>\n

– Nghe ph\u1ed5i \u0111\u1ea7y ran \u1ea9m c\u1ea3 hai ph\u1ed5i, b\u1eaft \u0111\u1ea7u \u1edf hai \u0111\u00e1y ph\u1ed5i, d\u00e2ng d\u1ea7n l\u00ean nh\u01b0 n\u01b0\u1edbc tri\u1ec1u d\u00e2ng.<\/p>\n

– Nh\u1ecbp tim nhanh (100 -140 l\u1ea7n ph\u00fat), c\u00f3 th\u1ec3 nghe th\u1ea5y nh\u1ecbp ng\u1ef1a phi tr\u00e1i, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i.<\/p>\n

– Huy\u1ebft \u00e1p c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c t\u0103ng<\/p>\n

– Ph\u00f9 ph\u1ed5i c\u1ea5p k\u00e9o d\u00e0i, mu\u1ed9n, b\u1ec7nh nh\u00e2n s\u1ebd suy h\u00f4 h\u1ea5p n\u1eb7ng, t\u1ee5t HA, r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c.<\/p>\n

– C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh l\u00fd nguy\u00ean nh\u00e2n ph\u00f9 ph\u1ed5i c\u1ea5p: rung t\u00e2m tr\u01b0\u01a1ng, tim ng\u1ef1a phi, ph\u00f9\u2026<\/p>\n

3.2. C\u1eadn l\u00e2m s\u00e0ng
\n<\/strong>
\n– XQ ph\u1ed5i: m\u1edd lan to\u1ea3 2 b\u00ean ph\u1ed5i, lan t\u1eeb r\u1ed1n ph\u1ed5i ra (h\u00ecnh c\u00e1nh b\u01b0\u1edbm); c\u00f3 th\u1ec3 th\u1ea5y b\u00f3ng tim to (ch\u1ec9 s\u1ed1 tim- ng\u1ef1c > 50%).<\/p>\n

\"xquang-phu-phoi-cap\"<\/p>\n

– Kh\u00ed m\u00e1u: PaO2<\/sub>\u00a0gi\u1ea3m, PaCO2<\/sub>\u00a0b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m<\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m v\u00e0 th\u0103m d\u00f2 kh\u00e1c:
\n. \u0110\u00e1nh gi\u00e1 huy\u1ebft \u0111\u1ed9ng: CVP (\u00e1p l\u1ef1c t\u0129nh m\u1ea1ch trung t\u00e2m); PCWP (\u00e1p l\u1ef1c mao m\u1ea1ch ph\u1ed5i b\u00edt) t\u0103ng; CO (cung l\u01b0\u1ee3ng tim) gi\u1ea3m
\n. \u0110i\u1ec7n t\u00e2m \u0111\u1ed3: c\u00f3 th\u1ec3 th\u1ea5y d\u1ea5u hi\u1ec7u NMCT, d\u1ea7y th\u1ea5t tr\u00e1i…<\/p>\n

– C\u00e1c x\u00e9t nghi\u1ec7m tu\u1ef3 theo nguy\u00ean nh\u00e2n ph\u00f9 ph\u1ed5i c\u1ea5p: t\u0103ng ure, creatinin trong suy th\u1eadn; t\u0103ng CKMB, troponin trong nh\u1ed3i m\u00e1u c\u01a1 tim. T\u0103ng bilirubin, men gan, gi\u1ea3m PT trong x\u01a1 gan\u2026<\/p>\n

3.3.Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t
\n<\/strong>
\na- Ph\u00f9 ph\u1ed5i c\u1ea5p t\u1ed5n th\u01b0\u01a1ng<\/p>\n

C\u01a1 ch\u1ebf:<\/u>\u00a0t\u1ed5n th\u01b0\u01a1ng m\u00e0ng ph\u1ebf nang mao m\u1ea1ch l\u00e0m t\u0103ng t\u00ednh th\u1ea5m m\u00e0ng ph\u1ebf nang mao m\u1ea1ch<\/p>\n

Nguy\u00ean nh\u00e2n<\/u>:
\n– Vi\u00eam ph\u1ed5i n\u1eb7ng do vi khu\u1ea9n ,vi rus
\n– B\u1ec7nh ph\u1ed5i do s\u1eb7c: d\u1ecbch v\u1ecb, th\u1ee9c \u0103n, d\u1ea7u
\n– Ng\u1ea1t n\u01b0\u1edbc
\n– H\u00edt ph\u1ea3i kh\u00ed \u0111\u1ed9c, th\u1edf oxy n\u1ed3ng \u0111\u1ed9 cao, k\u00e9o d\u00e0i…
\n– Ch\u1ea5n th\u01b0\u01a1ng ph\u1ed5i
\n– \u0110a ch\u1ea5n th\u01b0\u01a1ng
\n– S\u1ed1c nhi\u1ec5m khu\u1ea9n, nhi\u1ec5m khu\u1ea9n huy\u1ebft …<\/p>\n

Bi\u1ec3u hi\u1ec7n<\/u>
\n– Suy h\u00f4 h\u1ea5p ti\u1ebfn tri\u1ec3n t\u1eeb t\u1eeb, th\u01b0\u1eddng n\u1eb7ng t\u1eeb ng\u00e0y th\u1ee9 3 c\u1ee7a b\u1ec7nh, t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p kh\u00f4ng c\u1ea3i thi\u1ec7n v\u1edbi oxy 100%
\n– Kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u suy tim tr\u00e1i
\n– Kh\u00ed m\u00e1u PaO2<\/sub>\u00af\u00af, SaO2<\/sub>\u00af, PaCO2<\/sub>\u00af ho\u1eb7c b\u00ecnh th\u01b0\u1eddng, PaO2<\/sub>\/ FiO2<\/sub>< 200
\n– Huy\u1ebft \u0111\u1ed9ng: CVP b\u00ecnh th\u01b0\u1eddng, PCWP b\u00ecnh th\u01b0\u1eddng.
\n– XQ ph\u1ed5i h\u00ecnh \u1ea3nh m\u1edd kho\u1ea3ng k\u1ebd lan t\u1ecfa.<\/p>\n

b- C\u01a1n hen ph\u1ebf qu\u1ea3n c\u1ea5p: ti\u1ec1n s\u1eed hen ph\u1ebf qu\u1ea3n, ran kh\u00f4 l\u00e0 ch\u00ednh (ran r\u00edt, ran ng\u00e1y), c\u1ea3i thi\u1ec7n t\u1ed1t sau d\u00f9ng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n.<\/p>\n

c- \u0110\u1ee3t c\u1ea5p vi\u00eam ph\u1ebf qu\u1ea3n ph\u1ed5i m\u00e3n: ti\u1ec1n s\u1eed vi\u00eam ph\u1ebf qu\u1ea3n ph\u1ed5i m\u00e3n, ho kh\u1ea1c \u0111\u1eddm, d\u1ea5u hi\u1ec7u suy tim ph\u1ea3i…<\/p>\n

d- D\u1ecb v\u1eadt \u0111\u01b0\u1eddng th\u1edf: b\u1ec7nh s\u1eed (b\u1ec7nh c\u1ea3nh s\u1eb7c th\u1ee9c \u0103n, d\u1ecb v\u1eadt…), th\u1edf co k\u00e9o h\u00f5m \u1ee9c, ti\u1ebfng r\u00edt thanh qu\u1ea3n…<\/p>\n

4. \u0110i\u1ec1u tr\u1ecb
\n<\/strong><\/h2>\n

4.1.Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb
\n<\/strong>
\n– \u0110\u1ea3m b\u1ea3o th\u00f4ng kh\u00ed cho b\u1ec7nh nh\u00e2n<\/p>\n

– Gi\u1ea3m ti\u1ec1n g\u00e1nh v\u00e0 h\u1eadu g\u00e1nh<\/p>\n

– T\u0103ng c\u01b0\u1eddng co b\u00f3p c\u01a1 tim<\/p>\n

– \u0110i\u1ec1u tr\u1ecb theo nguy\u00ean nh\u00e2n g\u00e2y ph\u00f9 ph\u1ed5i c\u1ea5p<\/p>\n

4.2. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3
\n<\/strong>
\n4.2.1 \u00a0T\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n: n\u1ebfu kh\u00f4ng c\u00f3 t\u1ee5t huy\u1ebft \u00e1p, \u0111\u1eb7t b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf Fowler (n\u1eeda n\u1eb1m, n\u1eeda ng\u1ed3i), \u0111\u1ec3 h\u1ea1n ch\u1ebf m\u00e1u t\u0129nh m\u1ea1ch tr\u1edf v\u1ec1.<\/p>\n

4.2.2 \u0110\u1ea3m b\u1ea3o ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p: m\u1ee5c ti\u00eau: SaO2<\/sub>> 90%<\/p>\n

– N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f2n t\u1ec9nh, h\u1ee3p t\u00e1c t\u1ed1t: cho th\u1edf \u00f4xy li\u1ec1u cao qua m\u1eb7t n\u1ea1.N\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n c\u00f3 th\u1ec3 cho th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp (CPAP ho\u1eb7c BiPAP), ngo\u00e0i t\u00e1c d\u1ee5ng t\u0103ng trao \u0111\u1ed5i \u00f4xy t\u1ea1i ph\u1ed5i, th\u1edf m\u00e1y c\u00f2n l\u00e0m gi\u1ea3m ti\u1ec1n g\u00e1nh v\u00e0 h\u1eadu g\u00e1nh c\u1ee7a th\u1ea5t tr\u00e1i.<\/p>\n

– N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c: \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, th\u1edf m\u00e1y x\u00e2m nh\u1eadp v\u1edbi PEEP.<\/p>\n

– N\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7u co th\u1eaft ph\u1ebf qu\u1ea3n, c\u00f3 th\u1ec3 d\u00f9ng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n nh\u01b0 aminophylin truy\u1ec1n t\u0129nh m\u1ea1ch.<\/p>\n

4.2.3 Gi\u1ea3m ti\u1ec1n g\u00e1nh<\/p>\n

– Nitroglycerine<\/u>
\n\u00b7 T\u00e1c d\u1ee5ng nhanh
\n\u00b7 C\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n t\u0129nh m\u1ea1ch, gi\u00e3n nh\u1eb9 \u0111\u1ed9ng m\u1ea1ch, gi\u00e3n m\u1ea1ch v\u00e0nh.
\n\u00b7 \u0110\u01b0\u1eddng d\u00f9ng: ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i 0,3-0,4 mg\/10-15 ph\u00fat, ho\u1eb7c d\u1ea1ng x\u1ecbt d\u01b0\u1edbi l\u01b0\u1ee1i. N\u1ebfu t\u00ecnh tr\u1ea1ng n\u1eb7ng c\u00f3 th\u1ec3 d\u00f9ng truy\u1ec1n t\u0129nh m\u1ea1ch li\u1ec1u 5-20 mcg\/ph\u00fat (c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ebfn li\u1ec1u cao h\u01a1n, ph\u1ea3i gi\u1ea3m li\u1ec1u ho\u1eb7c ng\u1eebng n\u1ebfu HA t\u1ee5t, nh\u1ecbp tim qu\u00e1 nhanh).<\/p>\n

– Lasix<\/u>
\n\u00b7 T\u00e1c d\u1ee5ng ch\u1eadm h\u01a1n, nh\u01b0ng k\u00e9o d\u00e0i.
\n\u00b7 L\u1ee3i ti\u1ec3u, gi\u00e3n nh\u1eb9 t\u0129nh m\u1ea1ch.
\n\u00b7 Li\u1ec1u d\u00f9ng 0,5-1 mg\/kg ti\u00eam t\u0129nh m\u1ea1ch, tu\u1ef3 theo \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 d\u00f9ng l\u1eb7p l\u1ea1i.<\/p>\n

4.3.3.\u00a0Morphine<\/u>
\n\u00b7 T\u00e1c d\u1ee5ng gi\u00e3n t\u0129nh m\u1ea1ch nh\u1eb9, c\u00f2n c\u00f3 t\u00e1c d\u1ee5ng an th\u1ea7n.
\n\u00b7 Li\u1ec1u 1-3 mg ti\u00eam t\u0129nh m\u1ea1ch
\n\u00b7 Ch\u00fa \u00fd: li\u1ec1u cao c\u00f3 th\u1ec3 g\u00e2y \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p.<\/p>\n

4.2.4.Gi\u1ea3m h\u1eadu g\u00e1nh:<\/p>\n

N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng huy\u1ebft \u00e1p, t\u1ed1t nh\u1ea5t l\u00e0 d\u00f9ng thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p lo\u1ea1i truy\u1ec1n t\u0129nh m\u1ea1ch c\u00f3 t\u00e1c d\u1ee5ng nhanh, ng\u1eafn.
\n\u00b7 Nitroglycerine truy\u1ec1n t\u0129nh m\u1ea1ch.
\n\u00b7 Nicardipine (Loxen) truy\u1ec1n t\u0129nh m\u1ea1ch, li\u1ec1u 1-5 mg\/gi\u1edd.
\n\u00b7 Nitroprusside.
\n\u00b7 C\u0169ng c\u00f3 th\u1ec3 d\u00f9ng adalate 5-10 mg ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i.<\/p>\n

4.2.5.Tr\u1ee3 tim<\/p>\n

Dobutamine<\/u>
\n\u00b7 Catecholamine t\u1ed5ng h\u1ee3p, c\u00f3 t\u00e1c d\u1ee5ng t\u0103ng co b\u00f3p c\u01a1 tim m\u1ea1nh, nhanh, ng\u1eafn.
\n\u00b7 Truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c, li\u1ec1u 2-20 mcg\/kg\/ph\u00fat.<\/p>\n

Digoxin<\/u>
\n\u00b7 T\u00e1c d\u1ee5ng tr\u1ee3 tim ch\u1eadm (4-6 gi\u1edd), y\u1ebfu.
\n\u00b7 Ch\u1ee7 y\u1ebfu d\u00f9ng trong c\u00e1c t\u00ecnh hu\u1ed1ng c\u00f3 rung nh\u0129 nhanh, do c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m d\u1eabn truy\u1ec1n nh\u0129 th\u1ea5t.
\n\u00b7 Ti\u00eam t\u0129nh m\u1ea1ch 0,5-1 mg<\/p>\n

4.2.6.\u0110i\u1ec1u tr\u1ecb sau c\u1ea5p c\u1ee9u
\n\u0110i\u1ec1u tr\u1ecb theo nguy\u00ean nh\u00e2n g\u00e2y ph\u00f9 ph\u1ed5i c\u1ea5p, v\u00ed d\u1ee5 h\u1eb9p hai l\u00e1, t\u0103ng huy\u1ebft \u00e1p, suy v\u00e0nh, suy th\u1eadn c\u1ea5p…<\/p>\n

Ph\u00e1c \u0111\u1ed3 x\u1eed tr\u00ed ph\u00f9 ph\u1ed5i c\u1ea5p huy\u1ebft \u0111\u1ed9ng<\/strong><\/p>\n

– \u0110\u1ec3 b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf n\u1eeda n\u1eb1m n\u1eeda ng\u1ed3i, hai ch\u00e2n th\u00f5ng<\/p>\n

– Th\u1edf oxy qua m\u1eb7t n\u1ea1 8- 10l\/ph\u00fat. Cho BN\u00a0th\u1edf m\u00e1y qua m\u1eb7t n\u1ea1<\/em>\u00a0(CPAP ho\u1eb7c BiPAP) n\u1ebfu s\u1eb5n c\u00f3 m\u00e1y th\u1edf.<\/p>\n

– L\u1ee3i ti\u1ec3u: Lasix ti\u00eam t\u0129nh m\u1ea1ch 20mg x 2 \u1ed1ng, c\u00f3 th\u1ec3 ti\u00eam nh\u1eafc l\u1ea1i sau 15 ph\u00fat n\u1ebfu ch\u01b0a \u0111\u1ee1, c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ebfn 200mg (trong tr\u01b0\u1eddng h\u1ee3p suy th\u1eadn).<\/p>\n

– Morphine 5 – 10mg (1\/2 – 1 \u1ed1ng) ti\u00eam d\u01b0\u1edbi da ho\u1eb7c t\u0129nh m\u1ea1ch.<\/p>\n

–\u00a0Nitroglycerine<\/em>\u00a0ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i, ho\u1eb7c x\u1ecbt d\u01b0\u1edbi l\u01b0\u1ee1i, ho\u1eb7c truy\u1ec1n t\u0129nh m\u1ea1ch (Lenitral truy\u1ec1n t\u0129nh m\u1ea1ch 5 – 20 mcg\/ph).<\/p>\n

– N\u1ebfu t\u0103ng HA: Adalat nhanh 10mg 5-10 gi\u1ecdt d\u01b0\u1edbi l\u01b0\u1ee1i, nh\u1eafc l\u1ea1i sau 10 – 15 ph\u00fat n\u1ebfu HA kh\u00f4ng gi\u1ea3m. Ho\u1eb7c : Nicardipin (Loxen) truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1eb7c Nitroglycerine<\/p>\n

– T\u0103ng co b\u00f3p c\u01a1 tim: Digoxin 0,5-1mg ti\u00eam TM (rung nh\u0129 nhanh, suy tim tr\u00e1i c\u1ea5p); Dopamin: n\u1ebfu HA t\u1ee5t; Dobutamin: n\u1ebfu suy tim tr\u00e1i c\u1ea5p<\/p>\n

– Ph\u00f9 ph\u1ed5i c\u1ea5p n\u1eb7ng (ng\u1ea1t th\u1edf c\u1ea5p, t\u00edm nhi\u1ec1u, tr\u00e0o nhi\u1ec1u b\u1ecdt h\u1ed3ng, r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c, t\u1ee5t HA):\u00a0\u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, h\u00fat d\u1ecbch ph\u1ebf qu\u1ea3n;Th\u1edf m\u00e1y x\u00e2m nh\u1eadp (qua NKQ)\u00a0\u00b1\u00a0PEEP<\/em><\/p>\n

T\u00c0I LI\u1ec6U:\u00a0<\/strong><\/p>\n

    \n
  1. ThS. BS. Nguy\u00ea\u0303n Anh Tu\u00e2\u0301n, <\/strong>B\u00f4\u0323 m\u00f4n H\u00f4\u0300i s\u01b0\u0301c C\u00e2\u0301p c\u01b0\u0301u – \u0110a\u0323i ho\u0323c Y Ha\u0300 N\u00f4\u0323i<\/li>\n
  2. The Washington manual of medical therapeutics, 32nd edition, Lippincott Williams & Wilkins 2007.<\/li>\n
  3. Current Emergency Diagnosis & Treatment, 5th Edition. The McGraw-Hill Companies 2004<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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