{"id":3069,"date":"2023-04-10T19:07:41","date_gmt":"2023-04-10T12:07:41","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=3069"},"modified":"2023-04-19T15:01:13","modified_gmt":"2023-04-19T08:01:13","slug":"vai-tro-cua-tieu-cau-trong-chay-mau-trung-that-tren-benh-nhan-phau-thuat-tim-ho","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/10\/vai-tro-cua-tieu-cau-trong-chay-mau-trung-that-tren-benh-nhan-phau-thuat-tim-ho\/","title":{"rendered":"Vai tr\u00f2 c\u1ee7a ti\u1ec3u c\u1ea7u trong ch\u1ea3y m\u00e1u trung th\u1ea5t tr\u00ean b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim h\u1edf"},"content":{"rendered":"<p><strong>Ch\u1ea3y m\u00e1u trung th\u1ea5t l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng ch\u1ea3y m\u00e1u x\u1ea3y ra \u1edf khoang trung th\u1ea5t c\u1ee7a tim ho\u1eb7c trong c\u00e1c m\u00f4 xung quanh sau khi ph\u1eabu thu\u1eadt tim h\u1edf. \u0110\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u1ea5t c\u1ee7a ph\u1eabu thu\u1eadt tim h\u1edf, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng suy tim v\u00e0 t\u1eed vong.\u00a0<\/strong><\/p>\n<h2><strong>1.Gi\u1edbi thi\u1ec7u chung v\u1ec1 ti\u1ec3u c\u1ea7u<\/strong><\/h2>\n<ul>\n<li>Ti\u1ec3u c\u1ea7u \u0111\u01b0\u1ee3c cung c\u1ea5p d\u01b0\u1edbi d\u1ea1ng t\u1eeb m\u1ed9t ho\u1eb7c nhi\u1ec1u ng\u01b0\u1eddi hi\u1ebfn m\u00e1u, th\u01b0\u1eddng \u0111\u00f3ng g\u00f3i trong m\u1ed9t t\u00fai ch\u1ee9a s\u00e1u \u0111\u01a1n v\u1ecb, \u0111\u00e2y l\u00e0 l\u01b0\u1ee3ng th\u00f4ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u1ea5p cho ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh trung b\u00ecnh.<\/li>\n<li>M\u1ed7i \u0111\u01a1n v\u1ecb ch\u1ee9a kho\u1ea3ng 8 \u00d7 10\u00b9\u2070 ti\u1ec3u c\u1ea7u v\u00e0 c\u00f3 th\u1ec3 t\u0103ng s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u kho\u1ea3ng 7000-10,000\/\u03bcL \u1edf ng\u01b0\u1eddi l\u1edbn c\u00e2n n\u1eb7ng 75 kg. M\u1ed9t \u0111\u01a1n v\u1ecb ti\u1ec3u c\u1ea7u ch\u1ee9a 70% s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u trong m\u1ed9t \u0111\u01a1n v\u1ecb m\u00e1u t\u01b0\u01a1i, nh\u01b0ng ti\u1ec3u c\u1ea7u s\u1ebd gi\u1ea3m\u00a0 m\u1ed9t ph\u1ea7n ch\u1ee9c n\u0103ng trong qu\u00e1 tr\u00ecnh l\u01b0u tr\u1eef.<\/li>\n<li>Ti\u1ec3u c\u1ea7u \u0111\u01b0\u1ee3c l\u01b0u tr\u1eef \u1edf nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong v\u00f2ng n\u0103m ng\u00e0y v\u00e0 c\u00f3 tu\u1ed5i th\u1ecd l\u00e0 t\u00e1m ng\u00e0y. Nh\u1eefng ti\u1ec3u c\u1ea7u \u0111\u01b0\u1ee3c l\u01b0u tr\u1eef \u1edf 4\u00b0C ch\u1ec9 c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c trong v\u00f2ng 24 gi\u1edd (ch\u1ec9 c\u00f3 50-70% t\u1ed5ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a ti\u1ec3u c\u1ea7u c\u00f2n l\u1ea1i sau s\u00e1u gi\u1edd) v\u00e0 tu\u1ed5i th\u1ecd ch\u1ec9 l\u00e0 2-3 ng\u00e0y.Ngo\u00e0i ra, c\u1ea7n ph\u1ea3i \u0111\u1ea3m b\u1ea3o r\u1eb1ng ti\u1ec3u c\u1ea7u kh\u00f4ng b\u1ecb ch\u1ea5n \u0111\u1ed9ng hay rung \u0111\u1ed9ng m\u1ea1nh, v\u00ec \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0m h\u01b0 h\u1ecfng c\u1ea5u tr\u00fac c\u1ee7a ch\u00fang. Trong qu\u00e1 tr\u00ecnh b\u1ea3o qu\u1ea3n, c\u1ea7n ph\u1ea3i ki\u1ec3m tra \u0111\u1ecbnh k\u1ef3 ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a ti\u1ec3u c\u1ea7u \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o t\u00ednh ch\u1ea5t v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a ch\u00fang kh\u00f4ng b\u1ecb thay \u0111\u1ed5i. Vi\u1ec7c ki\u1ec3m tra n\u00e0y bao g\u1ed3m \u0111o ch\u1ec9 s\u1ed1 ch\u1ee9c n\u0103ng c\u1ee7a ti\u1ec3u c\u1ea7u v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a s\u1ef1 thay \u0111\u1ed5i trong t\u00ednh ch\u1ea5t c\u1ee7a ch\u00fang.<\/li>\n<\/ul>\n<h2><strong>2.Ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n ti\u1ec3u c\u1ea7u trong ch\u1ea3y m\u00e1u trung th\u1ea5t<\/strong><\/h2>\n<ul>\n<li>N\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.<\/li>\n<li>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.C\u00e1c v\u1ea5n \u0111\u1ec1 l\u01b0u \u00fd khi truy\u1ec1n ti\u1ec3u c\u1ea7u<\/strong><\/h2>\n<ul>\n<li>Ch\u1ee9c n\u0103ng c\u1ee7a ti\u1ec3u c\u1ea7u b\u1ecb suy gi\u1ea3m \u1edf b\u1ec7nh nh\u00e2n thi\u1ebfu fibrinogen,khi b\u1ec7nh nh\u00e2n thi\u1ebfu fibrinogen, qu\u00e1 tr\u00ecnh \u0111\u00f4ng m\u00e1u s\u1ebd b\u1ecb suy gi\u1ea3m v\u00e0 ti\u1ec3u c\u1ea7u s\u1ebd kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n ch\u1ee9c n\u0103ng c\u1ee7a n\u00f3 m\u1ed9t c\u00e1ch hi\u1ec7u qu\u1ea3. Khi \u0111\u00f3, nguy c\u01a1 xu\u1ea5t huy\u1ebft s\u1ebd t\u0103ng l\u00ean v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 g\u1eb7p ph\u1ea3i c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn ch\u1ea3y m\u00e1u nh\u01b0 ch\u1ea3y m\u00e1u n\u1ed9i t\u1ea1ng, ch\u1ea3y m\u00e1u ti\u00eau h\u00f3a v\u00e0 ch\u1ea3y m\u00e1u n\u00e3o v\u00e0 khi t\u1ef7 l\u1ec7 Hct th\u1ea5p h\u01a1n 30%. Vi\u1ec7c truy\u1ec1n m\u00e1u \u0111\u1ecf \u0111\u1ec3 n\u00e2ng t\u1ef7 l\u1ec7 Hct l\u00ean 26% c\u0169ng c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng c\u1ee7a ti\u1ec3u c\u1ea7u.<\/li>\n<li>Ti\u1ec3u c\u1ea7u \u0111\u01b0\u1ee3c truy\u1ec1n trong v\u00f2ng 4-6 gi\u1edd sau khi d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf P2Y12 s\u1ebd \u00edt hi\u1ec7u qu\u1ea3 h\u01a1n.\u0110i\u1ec1u n\u00e0y x\u1ea3y ra do ho\u1ea1t t\u00ednh c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf P2Y12 v\u1eabn c\u00f2n trong tu\u1ea7n ho\u00e0n m\u00e1u v\u00e0 c\u00f3 th\u1ec3 ng\u0103n ch\u1eb7n ti\u1ec3u c\u1ea7u k\u1ebft d\u00ednh v\u00e0 th\u1ef1c hi\u1ec7n ch\u1ee9c n\u0103ng c\u1ee7a n\u00f3.<\/li>\n<li>\u0110i\u1ec1u c\u1ea7n ch\u00fa \u00fd khi truy\u1ec1n ti\u1ec3u c\u1ea7u l\u00e0 t\u00ednh t\u01b0\u01a1ng th\u00edch ABO, nh\u01b0ng \u0111i\u1ec1u n\u00e0y kh\u00f4ng b\u1eaft bu\u1ed9c. \u0110\u1ed1i v\u1edbi m\u1ed7i ng\u01b0\u1eddi hi\u1ebfn m\u00e1u, c\u00f3 nguy c\u01a1 truy\u1ec1n nhi\u1ec5m vi\u00eam gan v\u00e0 HIV t\u01b0\u01a1ng t\u1ef1 nh\u01b0 m\u1ed9t \u0111\u01a1n v\u1ecb m\u00e1u.<\/li>\n<li>Ti\u1ec3u c\u1ea7u n\u00ean \u0111\u01b0\u1ee3c truy\u1ec1n qua b\u1ed9 l\u1ecdc 170 \u03bcm. C\u00f3 nhi\u1ec1u b\u1ed9 l\u1ecdc kh\u00e1c nhau (nh\u01b0 b\u1ed9 l\u1ecdc Pall LRF 10) c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 lo\u1ea1i b\u1ecf b\u1ea1ch c\u1ea7u t\u1eeb truy\u1ec1n ti\u1ec3u c\u1ea7u. Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c b\u1ed9 l\u1ecdc n\u00e0y c\u00f3 th\u1ec3 h\u1eefu \u00edch trong vi\u1ec7c gi\u1ea3m nguy c\u01a1 c\u00e1c ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng do t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u c\u00f3 m\u1eb7t trong bao ti\u1ec3u c\u1ea7u. Vi\u1ec7c d\u00f9ng kh\u00e1ng histamin v\u1edbi diphenhydramine (50 mg IV), ranitidin (150 mg IV) v\u00e0 steroid (hydrocortisone 100 mg IV) c\u00f3 th\u1ec3 gi\u1ea3m \u0111\u1ed9 k\u00edch \u1ee9ng n\u00e0y, nh\u01b0ng th\u01b0\u1eddng kh\u00f4ng c\u1ea7n thi\u1ebft.<\/li>\n<li>M\u1eb7c d\u00f9 c\u00f3 m\u1ed9t s\u1ed1 kh\u1eb3ng \u0111\u1ecbnh r\u1eb1ng truy\u1ec1n ti\u1ec3u c\u1ea7u li\u00ean quan \u0111\u1ebfn nguy c\u01a1 nhi\u1ec5m tr\u00f9ng, \u0111\u1ed9t qu\u1ef5&#8230;\u0111\u1eb7c bi\u1ec7t l\u00e0 khi s\u1eed d\u1ee5ng truy\u1ec1n ti\u1ec3u c\u1ea7u trong th\u1eddi gian d\u00e0i ho\u1eb7c v\u1edbi li\u1ec1u l\u01b0\u1ee3ng l\u1edbn. Ngo\u00e0i ra, truy\u1ec1n ti\u1ec3u c\u1ea7u c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng v\u1ec1 h\u00f4 h\u1ea5p, bao g\u1ed3m vi\u00eam ph\u1ed5i, suy h\u00f4 h\u1ea5p ho\u1eb7c kh\u00f3 th\u1edf do ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng.<\/li>\n<\/ul>\n<h2><strong>4.K\u1ebft lu\u1eadn v\u1ec1 vai tr\u00f2 c\u1ee7a ti\u1ec3u c\u1ea7u<\/strong><\/h2>\n<p>T\u00f3m t\u1eaft l\u1ea1i, ti\u1ec3u c\u1ea7u \u0111\u00f3ng vai tr\u00f2 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c ki\u1ec3m so\u00e1t ch\u1ea3y m\u00e1u trung th\u1ea5t tr\u00ean b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim h\u1edf. Thi\u1ebfu h\u1ee5t ti\u1ec3u c\u1ea7u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u n\u1eb7ng v\u00e0 nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng. Do \u0111\u00f3, \u0111\u1ea3m b\u1ea3o cung c\u1ea5p \u0111\u1ee7 ti\u1ec3u c\u1ea7u v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng khi truy\u1ec1n ti\u1ec3u c\u1ea7u l\u00e0 r\u1ea5t quan tr\u1ecdng trong ph\u1eabu thu\u1eadt tim h\u1edf. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd v\u00e0 \u0111\u00e1nh gi\u00e1 r\u1ee7i ro c\u1ee7a c\u00e1c bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 x\u1ea3y ra tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh truy\u1ec1n ti\u1ec3u c\u1ea7u.<\/p>\n<p>Tuy nhi\u00ean, c\u0169ng c\u1ea7n l\u01b0u \u00fd \u0111\u1ebfn c\u00e1c kh\u00f3 kh\u0103n v\u00e0 h\u1ea1n ch\u1ebf khi s\u1eed d\u1ee5ng ti\u1ec3u c\u1ea7u v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c truy\u1ec1n ti\u1ec3u c\u1ea7u. \u0110\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 th\u00e0nh c\u00f4ng c\u1ee7a ca ph\u1eabu thu\u1eadt, c\u00e1c b\u00e1c s\u0129 c\u1ea7n \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh h\u1ee3p l\u00fd v\u00e0 c\u00e2n nh\u1eafc k\u1ef9 l\u01b0\u1ee1ng khi s\u1eed d\u1ee5ng ti\u1ec3u c\u1ea7u trong ch\u1ea3y m\u00e1u trung th\u1ea5t tr\u00ean b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim h\u1edf.<\/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 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 hi\u1ec7n t\u01b0\u1ee3ng ch\u1ea3y m\u00e1u x\u1ea3y ra \u1edf khoang trung th\u1ea5t c\u1ee7a tim ho\u1eb7c trong c\u00e1c m\u00f4 xung quanh sau khi ph\u1eabu thu\u1eadt tim h\u1edf. \u0110\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m nh\u1ea5t c\u1ee7a ph\u1eabu thu\u1eadt tim h\u1edf, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng suy tim v\u00e0 t\u1eed vong.\u00a0 [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":3085,"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>Vai tr\u00f2 ti\u1ec3u c\u1ea7u trong ch\u1ea3y m\u00e1u trung th\u1ea5t<\/title>\n<meta name=\"description\" content=\"Vai tr\u00f2 c\u1ee7a ti\u1ec3u c\u1ea7u trong ch\u1ea3y m\u00e1u trung th\u1ea5t tr\u00ean b\u1ec7nh nh\u00e2n ph\u1eabu thu\u1eadt tim h\u1edf. 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