{"id":31759,"date":"2023-05-04T17:10:26","date_gmt":"2023-05-04T10:10:26","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31759"},"modified":"2023-05-04T17:10:26","modified_gmt":"2023-05-04T10:10:26","slug":"xu-tri-cap-cuu","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/xu-tri-cap-cuu\/","title":{"rendered":"X\u1eed tr\u00ed c\u1ea5p c\u1ee9u tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i"},"content":{"rendered":"

X\u1eed tr\u00ed c\u1ea5p c\u1ee9u tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i (TDMP) khi t\u00ecnh tr\u1ea1ng t\u00edch \u0111\u1ecdng d\u1ecbch qu\u00e1 m\u1ee9c b\u00ecnh th\u01b0\u1eddng trong khoang m\u00e0ng ph\u1ed5i. Khi TDMP nhi\u1ec1u ho\u1eb7c TDMP k\u00e8m theo r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, huy\u1ebft \u0111\u1ed9ng c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c x\u1eed tr\u00ed nhanh ch\u00f3ng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o t\u00ednh m\u1ea1ng cho b\u1ec7nh nh\u00e2n.<\/strong><\/p>\n

1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh TDMP c\u1ea7n x\u1eed tr\u00ed c\u1ea5p c\u1ee9u<\/strong><\/h1>\n

1.1. L\u00e2m s\u00e0ng<\/strong><\/h3>\n

– \u0110au ng\u1ef1c, ho khan, kh\u00f3 th\u1edf. Kh\u00e1m ph\u1ed5i c\u00f3 h\u1ed9i ch\u1ee9ng ba gi\u1ea3m.<\/p>\n

– C\u00e1c tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd TDMP c\u1ea7n c\u1ea5p c\u1ee9u:<\/p>\n

+ M\u1ec7t nhi\u1ec1u.<\/p>\n

+ D\u1ea5u hi\u1ec7u suy h\u00f4 h\u1ea5p: th\u1edf nhanh, n\u00f4ng, v\u00e3 m\u1ed3 h\u00f4i, tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 t\u00edm m\u00f4i v\u00e0 \u0111\u1ea7u chi, \u0111\u1ed9 b\u00e3o h\u00f2a oxy mao m\u1ea1ch < 90%.<\/p>\n

+ R\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng: nh\u1ecbp tim nhanh > 100 ck\/ph, huy\u1ebft \u00e1p h\u1ea1 < 90\/60 mmHg, ho\u1eb7c huy\u1ebft \u00e1p h\u1ea1 > 30 mmHg so v\u1edbi huy\u1ebft \u00e1p n\u1ec1n (\u1edf b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng huy\u1ebft \u00e1p). C\u00f3 bi\u1ec3u hi\u1ec7n b\u1ec7nh l\u00fd tim m\u1ea1ch: ph\u00f9, ti\u1ec3u \u00edt, c\u1ed5 tr\u01b0\u1edbng, gan to, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, nghe tim c\u00f3 ti\u1ebfng b\u1ea5t th\u01b0\u1eddng, r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/p>\n

+ T\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng: s\u1ed1t, m\u00f4i kh\u00f4, l\u01b0\u1ee1i b\u1ea9n, h\u01a1i th\u1edf h\u00f4i,\u2026<\/p>\n

+ T\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u: da xanh, ni\u00eam m\u1ea1c nh\u1ee3t, m\u1ea1ch nhanh, huy\u1ebft \u00e1p h\u1ea1.<\/p>\n

+ Kh\u00e1m h\u00f4 h\u1ea5p: l\u1ed3ng ng\u1ef1c c\u0103ng ph\u1ed3ng, c\u00e1c khoang li\u00ean s\u01b0\u1eddn gi\u00e3n r\u1ed9ng, c\u00f3 th\u1ec3 s\u1edd th\u1ea5y gan (ho\u1eb7c l\u00e1ch) d\u01b0\u1edbi b\u1edd s\u01b0\u1eddn do b\u1ecb d\u1ecbch \u0111\u1ea9y xu\u1ed1ng.<\/p>\n

1.2. C\u00e1c d\u1ea5u hi\u1ec7u c\u1eadn l\u00e2m s\u00e0ng \u1edf BN TDMP c\u1ea7n c\u1ea5p c\u1ee9u<\/strong><\/h3>\n

T\u00f9y theo t\u1eebng b\u1ec7nh l\u00fd c\u1ee5 th\u1ec3, c\u00f3 th\u1ec3 g\u1eb7p m\u1ed9t ho\u1eb7c nhi\u1ec1u d\u1ea5u hi\u1ec7u sau:<\/p>\n

– X-quang ph\u1ed5i chu\u1ea9n: h\u00ecnh m\u1edd \u0111\u1eadm, \u0111\u1ed3ng \u0111\u1ec1u qu\u00e1 ph\u1ed5i ho\u1eb7c ph\u1ed5i tr\u1eafng, trung th\u1ea5t v\u00e0 kh\u00ed qu\u1ea3n b\u1ecb \u0111\u1ea9y l\u1ec7ch sang b\u00ean \u0111\u1ed1i di\u1ec7n.<\/p>\n

– C\u00f4ng th\u1ee9c m\u00e1u:<\/p>\n

+ Tr\u00e0n m\u1ee7 MP: s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng, t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh t\u0103ng.<\/p>\n

+ Tr\u00e0n m\u00e1u MP: h\u1ed3ng c\u1ea7u gi\u1ea3m, hemoglobin gi\u1ea3m, t\u1ef7 l\u1ec7 Hb DMP\/Hb m\u00e1u > 0,5.<\/p>\n

– Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch: PaO2<\/sub>\u00a0< 60 mmHg; SaO2<\/sub>\u00a0< 90%.<\/p>\n

– \u0110i\u1ec7n tim c\u00f3 th\u1ec3 th\u1ea5y: c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim, h\u00ecnh \u1ea3nh t\u0103ng g\u00e1nh c\u00e1c bu\u1ed3ng tim trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/p>\n

– Ch\u1ecdc d\u00f2 m\u00e0ng ph\u1ed5i:<\/p>\n

+ D\u1ecbch m\u00e1u: Hb d\u1ecbch MP\/ Hb m\u00e1u > 0,5.<\/p>\n

+ D\u1ecbch m\u00e0u m\u00e1u: d\u1ecbch m\u00e0u \u0111\u1ecf m\u00e1u, nh\u01b0ng t\u1ef7 l\u1ec7 Hb d\u1ecbch MP\/ Hb m\u00e1u < 0,5.<\/p>\n

+ D\u1ecbch \u0111\u1ee5c m\u1ee7 ho\u1eb7c m\u1ee7 r\u00f5.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed c\u1ea5p c\u1ee9u c\u00e1c tr\u01b0\u1eddng h\u1ee3p TDMP<\/strong><\/h2>\n

T\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p TDMP d\u00f9 do nguy\u00ean nh\u00e2n g\u00ec nh\u01b0ng n\u1ebfu m\u1ee9c \u0111\u1ed9 nhi\u1ec1u ho\u1eb7c \u1ea3nh h-\u1edfng \u0111\u1ebfn h\u00f4 h\u1ea5p, huy\u1ebft \u0111\u1ed9ng \u0111\u1ec1u c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed c\u1ea5p c\u1ee9u.<\/p>\n

C\u00e1c bi\u1ec7n ph\u00e1p chung:<\/p>\n

– Th\u1edf oxy \u0111\u1ea3m b\u1ea3o \u0111\u1ed9 b\u00e3o h\u00f2a oxy mao m\u1ea1ch > 90%.<\/p>\n

– \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng \u0111\u1ec3 c\u00f3 x\u1eed tr\u00ed ph\u00f9 h\u1ee3p nh\u1eb1m \u0111\u1ea3m b\u1ea3o \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng.<\/p>\n

– Ch\u1ecdc th\u00e1o d\u1ecbch ho\u1eb7c m\u1edf m\u00e0ng ph\u1ed5i t\u1ed1i thi\u1ec3u d\u1eabn l\u01b0u d\u1ecbch nh\u1eb1m c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng h\u00f4 h\u1ea5p. M\u1ed7i l\u1ea7n ch\u1ecdc th\u00e1o kh\u00f4ng qu\u00e1 1l.<\/p>\n

– Kh\u1ea9n tr\u01b0\u01a1ng ti\u1ebfn h\u00e0nh c\u00e1c x\u00e9t nghi\u1ec7m th\u0103m d\u00f2 \u0111\u1ec3 t\u00ecm nguy\u00ean nh\u00e2n TDMP.<\/p>\n

\"\"
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Ngu\u1ed3n: Medicover Hospitals<\/strong><\/figcaption><\/figure>\n

2.1. X\u1eed tr\u00ed c\u1ea5p c\u1ee9u TDMP nhi\u1ec1u \u1edf b\u1ec7nh nh\u00e2n c\u00f3 suy tim<\/strong><\/h3>\n

– Ti\u1ec1n s\u1eed c\u00f3 b\u1ec7nh l\u00fd tim m\u1ea1ch: b\u1ec7nh van tim, THA, nh\u1ed3i m\u00e1u c\u01a1 tim, suy v\u00e0nh.<\/p>\n

– L\u00e2m s\u00e0ng: \u0111au ng\u1ef1c, kh\u00f3 th\u1edf, th\u1edf nhanh n\u00f4ng, HA t\u0103ng ho\u1eb7c h\u1ea1 huy\u1ebft \u00e1p, nghe tim th\u1ea5y b\u1ea5t th\u01b0\u1eddng g\u1ee3i \u00fd b\u1ec7nh tim m\u1ea1ch: T1 \u0111anh, rung t\u00e2m tr\u01b0\u01a1ng, th\u1ed5i t\u00e2m thu,X ti\u1ebfng ng\u1ef1a phi<\/p>\n

– C\u1eadn l\u00e2m s\u00e0ng:<\/p>\n

+ XQ ph\u1ed5i: h\u00ecnh \u1ea3nh TDMP, b\u00f3ng tim to.<\/p>\n

+ \u0110i\u1ec7n tim: d\u1ea5u hi\u1ec7u suy tim tr\u00e1i, suy tim ph\u1ea3i ho\u1eb7c suy tim to\u00e0n b\u1ed9, c\u00f3 th\u1ec3 c\u00f3 bi\u1ec3u hi\u1ec7n b\u1ec7nh l\u00fd m\u1ea1ch v\u00e0nh.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb:<\/p>\n

+ Ch\u1ecdc th\u00e1o DMP khi TDMP nhi\u1ec1u g\u00e2y kh\u00f3 th\u1edf, ho\u1eb7c c\u00f3 \u0111\u1ea9y l\u1ec7ch trung th\u1ea5t sang b\u00ean \u0111\u1ed1i di\u1ec7n.<\/p>\n

+ \u0110i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/p>\n

2.2. X\u1eed tr\u00ed c\u1ea5p c\u1ee9u TDMP nhi\u1ec1u do b\u1ec7nh l\u00fd \u00e1c t\u00ednh, b\u1ec7nh nh\u00e2n suy ki\u1ec7t<\/strong><\/h3>\n

– Ti\u1ec1n s\u1eed: c\u00f3\/kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n TDMP do ung th\u01b0<\/p>\n

– L\u00e2m s\u00e0ng: th\u1ec3 tr\u1ea1ng g\u1ea7y, suy ki\u1ec7t, c\u00f3 th\u1ec3 c\u00f3 h\u1ea1ch ngo\u1ea1i vi do di c\u0103n ung th\u01b0. L\u1ed3ng ng\u1ef1c b\u00ean tr\u00e0n d\u1ecbch v\u1ed3ng c\u0103ng.<\/p>\n

– Xq ph\u1ed5i: TDMP nhi\u1ec1u, ho\u1eb7c m\u1edd to\u00e0n b\u1ed9 m\u1ed9t b\u00ean, c\u00f3 th\u1ec3 \u0111\u00e8 \u0111\u1ea9y trung th\u1ea5t.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb: Ch\u1ecdc th\u00e1o DMP ho\u1eb7c \u0111\u1eb7t d\u1eabn l\u01b0u MP.<\/p>\n

2.3. TDMP \u1edf b\u1ec7nh nh\u00e2n c\u00f3 vi\u00eam ph\u1ed5i<\/strong><\/h3>\n

– L\u00e2m s\u00e0ng: s\u1ed1t, ho kh\u1ea1c \u0111\u1eddm, \u0111au ng\u1ef1c, c\u00f3 th\u1ec3 kh\u00f3 th\u1edf khi vi\u00eam ph\u1ed5i n\u1eb7ng ho\u1eb7c TDMP nhi\u1ec1u. Nghe ph\u1ed5i c\u00f3 ran, kh\u00e1m c\u00f3 h\u1ed9i ch\u1ee9ng ba gi\u1ea3m.<\/p>\n

– XQ ph\u1ed5i: h\u00ecnh \u1ea3nh TDMP, t\u1ed5n th\u01b0\u01a1ng \u0111\u00f4ng \u0111\u1eb7c (nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p ph\u1ea3i ch\u1ee5p X-quang ph\u1ed5i sau ch\u1ecdc th\u00e1o h\u1ebft d\u1ecbch m\u00e0ng ph\u1ed5i m\u1edbi th\u1ea5y h\u00ecnh t\u1ed5n th\u01b0\u01a1ng \u0111\u00f4ng \u0111\u1eb7c). CTM c\u00f3 b\u1ea1ch c\u1ea7u v\u00e0 t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u trung t\u00ednh t\u0103ng cao.<\/p>\n

– Ch\u1ecdc d\u00f2 MP l\u1ea5y d\u1ecbch x\u00e9t nghi\u1ec7m t\u1ebf b\u00e0o h\u1ecdc, nu\u00f4i c\u1ea5y vi khu\u1ea9n, nhu\u1ed9m soi. N\u1ebfu s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u t\u0103ng, nhi\u1ec1u b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n tho\u00e1i h\u00f3a: c\u1ea7n m\u1edf m\u00e0ng ph\u1ed5i t\u1ed1i thi\u1ec3u d\u1eabn l\u01b0u v\u00e0 \u0111i\u1ec1u tr\u1ecb nh\u01b0 tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i.<\/p>\n

2.4. X\u1eed tr\u00ed c\u1ea5p c\u1ee9u tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i<\/strong><\/h3>\n

– B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng n\u1eb7ng: s\u1ed1t cao, b\u1ea1ch c\u1ea7u m\u00e1u ngo\u1ea1i vi t\u0103ng cao, t\u1ef7 l\u1ec7 b\u1ea1ch c\u1ea7u trung t\u00ednh t\u0103ng. Ch\u1ecdc d\u00f2 m\u00e0ng ph\u1ed5i ra m\u1ee7.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb c\u1ea7n m\u1edf m\u00e0ng ph\u1ed5i d\u1eabn l\u01b0u m\u1ee7 s\u1edbm, h\u00fat \u00e1p l\u1ef1c \u00e2m 15 cmH2<\/sub>O, r\u1eeda m\u00e0ng ph\u1ed5i qua d\u1eabn l\u01b0u h\u00e0ng ng\u00e0y. N\u1ebfu l\u01b0\u1ee3ng d\u1ecbch m\u1ee7 nhi\u1ec1u, c\u1ea7n th\u00e1o d\u1ecbch t\u1eeb t\u1eeb tr\u00e1nh ph\u00f9 ph\u1ed5i c\u1ea5p. N\u1ebfu tr\u00e0n m\u1ee7 khu tr\u00fa ho\u1eb7c l\u01b0\u1ee3ng d\u1ecbch m\u1ee7 \u00edt c\u1ea7n m\u1edf MP d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m ho\u1eb7c ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u1ef1c. Tr\u01b0\u1eddng h\u1ee3p m\u1ee7 \u0111\u1eb7c, kh\u00f3 h\u00fat ho\u1eb7c nhi\u1ec1u \u1ed5 m\u1ee7 khu tr\u00fa x\u00e9t b\u01a1m Streptokinase v\u00e0o khoang MP.<\/p>\n

– Kh\u00e1ng sinh li\u1ec1u cao, ph\u1ed1i h\u1ee3p \u0111\u01b0\u1eddng to\u00e0n th\u00e2n (tham kh\u1ea3o th\u00eam b\u00e0i h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i).<\/p>\n

2.5. TDMP \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nh\u1ed3i m\u00e1u ph\u1ed5i: th\u01b0\u1eddng tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i l\u01b0\u1ee3ng \u00edt<\/strong><\/h3>\n

– B\u1ec7nh nh\u00e2n c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1: b\u1ea5t \u0111\u1ed9ng l\u00e2u ng\u00e0y, g\u00e3y x\u01b0\u01a1ng, sau ph\u1eabu thu\u1eadt v\u00f9ng b\u1ee5ng, ti\u1ec3u khung, c\u00f3 b\u1ec7nh l\u00fd tim m\u1ea1ch<\/p>\n

– L\u00e2m s\u00e0ng: \u0111au ng\u1ef1c, kh\u00f3 th\u1edf, ho m\u00e1u, n\u1eb7ng c\u00f3 th\u1ec3 suy h\u00f4 h\u1ea5p, suy tu\u1ea7n ho\u00e0n. C\u00e1c d\u1ea5u hi\u1ec7u kh\u00f3 th\u1edf th\u01b0\u1eddng do nh\u1ed3i m\u00e1u ph\u1ed5i h\u01a1n l\u00e0 do tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i.<\/p>\n

– C\u1eadn l\u00e2m s\u00e0ng: \u0110i\u1ec7n tim c\u00f3 h\u00ecnh \u1ea3nh S1Q3, X-quang ph\u1ed5i c\u00f3 h\u00ecnh \u1ea3nh TDMP, t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 ph\u1ed5i, MSCT \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u00f3 th\u1ec3 th\u1ea5y huy\u1ebft kh\u1ed1i, \u0111\u1ecbnh l\u01b0\u1ee3ng D-dimer > 500 mg\/dl.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb: ch\u1ee7 y\u1ebfu \u0111i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd ch\u00ednh (b\u1ea5t \u0111\u1ed9ng, thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng, thu\u1ed1c ti\u00eau huy\u1ebft kh\u1ed1i), ch\u1ec9 ch\u1ecdc th\u00e1o DMP khi d\u1ecbch nhi\u1ec1u \u1ea3nh h-\u1edfng \u0111\u1ebfn h\u00f4 h\u1ea5p, huy\u1ebft \u0111\u1ed9ng.<\/p>\n

2.6. Tr\u00e0n m\u00e1u m\u00e0ng ph\u1ed5i<\/strong><\/h3>\n

– L\u00e2m s\u00e0ng: \u0111au ng\u1ef1c, kh\u00f3 th\u1edf. Kh\u00e1m th\u1ea5y da xanh, ni\u00eam m\u1ea1c nh\u1ee3t, m\u1ea1ch nhanh, huy\u1ebft \u00e1p h\u1ea1, nh\u1ecbp th\u1edf nhanh, ph\u1ed5i c\u00f3 h\u1ed9i ch\u1ee9ng ba gi\u1ea3m.<\/p>\n

– C\u1eadn l\u00e2m s\u00e0ng: X-quang ph\u1ed5i c\u00f3 h\u00ecnh \u1ea3nh TDMP, ch\u1ecdc d\u00f2 MP c\u00f3 d\u1ecbch m\u00e1u, hemoglobin DMP\/m\u00e1u > 50%, CTM c\u00f3 h\u1ed3ng c\u1ea7u, Hb, huy\u1ebft s\u1eafc t\u1ed1 gi\u1ea3m.<\/p>\n

– C\u00e1c c\u0103n nguy\u00ean g\u00e2y tr\u00e0n m\u00e1u MP v\u00e0 x\u1eed tr\u00ed c\u1ea5p c\u1ee9u.<\/p>\n

+ Ch\u1ea5n th\u01b0\u01a1ng ng\u1ef1c k\u00edn: B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed ch\u1ea5n th\u01b0\u01a1ng, X-quang ph\u1ed5i\/CT ng\u1ef1c c\u00f3 th\u1ec3 c\u00f3 g\u00e3y x\u01b0\u01a1ng s\u01b0\u1eddn, \u0111\u1ee5ng d\u1eadp nhu m\u00f4 ph\u1ed5i ho\u1eb7c tr\u00e0n kh\u00ed tr\u00e0n d\u1ecbch MP. \u0110i\u1ec1u tr\u1ecb: b\u00f9 kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n b\u1eb1ng ch\u1ebf ph\u1ea9m m\u00e1u v\u00e0 d\u1ecbch, c\u1ed1 \u0111\u1ecbnh m\u1ea3ng s\u01b0\u1eddn di \u0111\u1ed9ng n\u1ebfu c\u00f3, m\u1edf m\u00e0ng ph\u1ed5i d\u1eabn l\u01b0u m\u00e1u, theo d\u00f5i l\u01b0\u1ee3ng m\u00e1u m\u1ea5t, n\u1ebfu > 1000 ml ho\u1eb7c > 300 ml\/3 gi\u1edd c\u00f3 ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt. Ph\u1ed1i h\u1ee3p v\u1edbi chuy\u00ean khoa ngo\u1ea1i \u0111\u1ec3 theo d\u00f5i v\u00e0 k\u1ecbp th\u1eddi can thi\u1ec7p b\u1eb1ng ph\u1eabu thu\u1eadt n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/p>\n

+ V\u1ee1 ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c: ti\u1ec1n s\u1eed THA, c\u00f3 th\u1ec3 c\u00f3 ch\u00eanh l\u1ec7ch HA 2 tay, MSCT \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh ph\u00ecnh t\u00e1ch \u0110MC. \u0110i\u1ec1u tr\u1ecb: c\u1ea7n can thi\u1ec7p ngo\u1ea1i khoa c\u1ea5p c\u1ee9u. Kh\u00f4ng m\u1edf m\u00e0ng ph\u1ed5i d\u1eabn l\u01b0u v\u00ec c\u00f3 th\u1ec3 l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng v\u1ee1 ph\u00ecnh t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/p>\n

+ Do th\u1ee7 thu\u1eadt can thi\u1ec7p: ch\u1ecdc d\u00f2 m\u00e0ng ph\u1ed5i, sinh thi\u1ebft m\u00e0ng ph\u1ed5i, \u0111\u1eb7t catheter t\u0129nh m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n. \u0110i\u1ec1u tr\u1ecb tr\u01b0\u1edbc ti\u00ean c\u1ea7n b\u00f9 d\u1ecbch kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n h\u00f2a, m\u1edf m\u00e0ng ph\u1ed5i d\u1eabn l\u01b0u m\u00e1u b\u1eb1ng \u1ed1ng d\u1eabn l\u01b0u c\u00f3 \u0111\u01b0\u1eddng k\u00ednh l\u1edbn, n\u1ebfu l\u01b0\u1ee3ng m\u00e1u ch\u1ea3y ra qua d\u1eabn l\u01b0u > 1000 ml ho\u1eb7c > 300 ml\/3 gi\u1edd c\u00f3 ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p ph\u1eabu thu\u1eadt c\u1ea7m m\u00e1u.<\/p>\n

+ Nh\u1ed3i m\u00e1u ph\u1ed5i: n\u1ebfu c\u00f3 tr\u00e0n m\u00e1u th\u01b0\u1eddng s\u1ed1 l\u01b0\u1ee3ng \u00edt.<\/p>\n

2.7. Tr\u00e0n m\u00e1u – tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i<\/strong><\/h3>\n

– Hay g\u1eb7p do v\u1ee1 k\u00e9n kh\u00ed k\u00e8m theo \u0111\u1ee9t d\u00e2y ch\u1eb1ng, d\u00e0y d\u00ednh m\u00e0ng ph\u1ed5i.<\/p>\n

– Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng: kh\u00f3 th\u1edf, \u0111au ng\u1ef1c \u0111\u1ed9t ng\u1ed9t, kh\u00e1m c\u00f3 tam ch\u1ee9ng Gaillard ph\u00eda tr\u00ean c\u1ee7a ph\u1ed5i v\u00e0 h\u1ed9i ch\u1ee9ng 3 gi\u1ea3m ph\u1ea7n d\u01b0\u1edbi. X-quang ph\u1ed5i c\u00f3 h\u00ecnh \u1ea3nh tr\u00e0n kh\u00ed tr\u00e0n d\u1ecbch MP v\u1edbi m\u1ee9c n\u01b0\u1edbc h\u01a1i, ch\u1ecdc d\u00f2 MP c\u00f3 m\u00e1u.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb: c\u1ea7n m\u1edf MP d\u1eabn l\u01b0u d\u1ecbch, kh\u00ed. Theo d\u00f5i s\u00e1t to\u00e0n tr\u1ea1ng b\u1ec7nh nh\u00e2n, s\u1ed1 l\u01b0\u1ee3ng m\u00e1u ch\u1ea3y qua d\u1eabn l\u01b0u x\u00e9t can thi\u1ec7p ph\u1eabu thu\u1eadt.<\/p>\n

– C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c:<\/p>\n

+ Ch\u1ea5n th\u01b0\u01a1ng ng\u1ef1c k\u00edn x\u1eed tr\u00ed nh\u01b0 tr\u00e0n m\u00e1u MP.<\/p>\n

+ Sau ch\u1ecdc d\u00f2 m\u00e0ng ph\u1ed5i \u1edf b\u1ec7nh nh\u00e2n TDMP: n\u1ebfu tr\u00e0n kh\u00ed nhi\u1ec1u m\u1edf m\u00e0ng ph\u1ed5i d\u1eabn l\u01b0u d\u1ecbch, kh\u00ed.<\/p>\n

2.8. Tr\u00e0n d\u01b0\u1ee1ng ch\u1ea5p m\u00e0ng ph\u1ed5i<\/strong><\/h3>\n

– \u0110\u1eb7c \u0111i\u1ec3m: d\u1ecbch m\u00e0ng ph\u1ed5i tr\u1eafng \u0111\u1ee5c nh\u01b0 s\u1eefa, \u0111\u1ecbnh l\u01b0\u1ee3ng m\u1ee1 to\u00e0n ph\u1ea7n 1-4 g\/100 ml, triglycerid > 110 mg\/dl.<\/p>\n

– C\u0103n nguy\u00ean c\u00f3 th\u1ec3 do ch\u1ea5n th\u01b0\u01a1ng ng\u1ef1c, ph\u1eabu thu\u1eadt l\u1ed3ng ng\u1ef1c g\u00e2y r\u00f2 \u1ed1ng ng\u1ef1c, m\u00e0ng ph\u1ed5i; di c\u0103n ung th\u01b0 b\u1ea1ch m\u1ea1ch, vi\u00eam b\u1ea1ch m\u1ea1ch do giun ch\u1ec9…<\/p>\n

– \u0110i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u khi tr\u00e0n d\u01b0\u1ee1ng ch\u1ea5p nhi\u1ec1u \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u00f4 h\u1ea5p, huy\u1ebft \u0111\u1ed9ng, ch\u1ee7 y\u1ebfu b\u1eb1ng c\u00e1ch ch\u1ecdc th\u00e1o ho\u1eb7c m\u1edf m\u00e0ng ph\u1ed5i d\u1eabn l\u01b0u.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n g\u00e2y tr\u00e0n d\u01b0\u1ee1ng ch\u1ea5p m\u00e0ng ph\u1ed5i. C\u00f3 th\u1ec3 c\u1ea7n ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt ho\u1eb7c g\u00e2y d\u00ednh m\u00e0ng ph\u1ed5i \u0111\u1ec3 d\u1ef1 ph\u00f2ng t\u00e1i ph\u00e1t.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o:<\/strong> H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh h\u00f4 h\u1ea5p c\u1ee7a B\u1ed9 Y t\u1ebf 2012<\/p>\n","protected":false},"excerpt":{"rendered":"

X\u1eed tr\u00ed c\u1ea5p c\u1ee9u tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i (TDMP) khi t\u00ecnh tr\u1ea1ng t\u00edch \u0111\u1ecdng d\u1ecbch qu\u00e1 m\u1ee9c b\u00ecnh th\u01b0\u1eddng trong khoang m\u00e0ng ph\u1ed5i. Khi TDMP nhi\u1ec1u ho\u1eb7c TDMP k\u00e8m theo r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, huy\u1ebft \u0111\u1ed9ng c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c x\u1eed tr\u00ed nhanh ch\u00f3ng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o t\u00ednh m\u1ea1ng cho b\u1ec7nh nh\u00e2n. 1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"\nX\u1eed tr\u00ed c\u1ea5p c\u1ee9u tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i - Vinmec<\/title>\n<meta name=\"description\" content=\"X\u1eed tr\u00ed c\u1ea5p c\u1ee9u tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i (TDMP) khi t\u00ecnh tr\u1ea1ng t\u00edch \u0111\u1ecdng d\u1ecbch qu\u00e1 m\u1ee9c b\u00ecnh th\u01b0\u1eddng trong khoang m\u00e0ng ph\u1ed5i. 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