{"id":32387,"date":"2023-05-07T16:51:12","date_gmt":"2023-05-07T09:51:12","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32387"},"modified":"2023-05-07T16:51:12","modified_gmt":"2023-05-07T09:51:12","slug":"quan-ly-benh-tim-bam-sinh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/quan-ly-benh-tim-bam-sinh\/","title":{"rendered":"Qu\u1ea3n l\u00fd b\u1ec7nh tim b\u1ea9m sinh"},"content":{"rendered":"

Qu\u1ea3n l\u00fd b\u1ec7nh tim b\u1ea9m sinh<\/a> \u0111\u00f2i h\u1ecfi li\u00ean t\u1ee5c t\u1eeb c\u00e1c chuy\u00ean gia y t\u1ebf, b\u1ec7nh nh\u00e2n v\u00e0 gia \u0111\u00ecnh. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 v\u1ea5n \u0111\u1ec1 qu\u1ea3n l\u00fd b\u1ec7nh tim b\u1ea9m sinh c\u1ea7n \u0111\u01b0\u1ee3c quan t\u00e2m:<\/strong><\/p>\n

1. Bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh tim b\u1ea9m sinh c\u00f3 t\u00edm<\/h2>\n

Thi\u1ebfu oxy m\u1ea1n t\u00ednh <\/strong>d\u1ea7n \u0111\u1ebfn t\u0103ng s\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u v\u00e0 t\u0103ng th\u1ec3 t\u00edch m\u00e1u. C\u01a1 ch\u1ebf b\u00f9 tr\u1eeb n\u00e0y gi\u00fap t\u0103ng kh\u1ea3 n\u0103ng v\u1eadn chuy\u1ec3n oxy tuy nhi\u00ean c\u00f3 th\u1ec3 g\u00e2y tri\u1ec7u ch\u1ee9ng do c\u00f4 \u0111\u1eb7c m\u00e1u.<\/p>\n

Tri\u1ec7u ch\u1ee9ng c\u00f4 \u0111\u1eb7c m\u00e1u: \u0110au \u0111\u1ea7u, r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c (nh\u00ecn m\u1edd ho\u1eb7c nh\u00ecn \u0111\u00f4i), gi\u1ea3m \u00fd th\u1ee9c, m\u1ec7t, li\u1ec7t, \u00f9 tai, \u0111au c\u01a1, y\u1ebfu c\u01a1, \u0111\u1ecf ch\u00e2n, c\u01a1n thi\u1ebfu m\u00e1u n\u00e3o tho\u00e1ng qua ho\u1eb7c nh\u1ed3i m\u00e1u n\u00e3o .<\/p>\n

Ch\u1ec9 s\u1ed1 quan tr\u1ecdng l\u00e0 n\u1ed3ng \u0111\u1ed9 Hemoglobin (Hb) v\u00e0 s\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u.<\/em><\/p>\n

R\u00fat m\u00e1u <\/em>c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n c\u00f3 Hb > 20 g\/dL ho\u1eb7c khi Hct > 65% v\u00e0 c\u00f3 tri\u1ec7u ch\u1ee9ng c\u00f4 \u0111\u1eb7c m\u00e1u tr\u00ean l\u00e2m s\u00e0ng . R \u00fat t\u1ed1i \u0111a 500 ml m\u1ed7i l\u1ea7n v\u00e0 truy\u1ec1n d\u1ecbch thay th\u1ebf \u0111\u1ed3ng th\u1eddi (d\u1ecbch truy\u1ec1n NaCl 0,9% ho\u1eb7c g lucose 5%) .<\/p>\n

Kh\u00f4ng n\u00ean r\u00fat m\u00e1u qu\u00e1 hai l\u1ea7n m\u1ed7i n\u0103m v\u00ec l\u00e0m t\u0103ng nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 do thi\u1ebfu s\u1eaft. N\u00ean s\u1eed d\u1ee5ng m\u00e0ng l\u1ecdc cho \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch.<\/p>\n

Thi\u1ebfu s\u1eaft<\/strong>: C\u1ea7n b\u1ed5 sung s\u1eaft t\u00edch c\u1ef1c (s\u1eaft sulphate 600mg \u0111\u01b0\u1eddng u\u1ed1ng m\u1ed7i ng\u00e0y) \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111a h\u1ed3ng c\u1ea7u, ki\u1ec3m tra l\u1ea1i n\u1ed3ng \u0111\u1ed9 Hb sau 8 – 10 ng\u00e0y \u0111i\u1ec1u tr\u1ecb.<\/p>\n

Nhi\u1ec1u b\u1ec7nh nh\u00e2n k\u00e9m dung n\u1ea1p s\u1eaft qua \u0111\u01b0\u1eddng u\u1ed1ng (bi\u1ec3u hi\u1ec7n: \u0110 au b\u1ee5ng, ti\u00eau ch\u1ea3y, t\u00e1o b\u00f3n); \u0111\u1eb7c bi\u1ec7t \u1edf c\u00e1c b\u1ec7nh nh\u00e2n suy tim t\u00e2m thu, s\u1eaft kh\u00f3 h\u1ea5p thu, b\u1ec7nh tim c\u00f3 t\u00edm v \u1edbi \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch cao (gan to v\u00e0 t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1eeda), v\u00ec th\u1ebf c\u1ea7n xem x\u00e9t b\u1ed5 sung s\u1eaft \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch.<\/p>\n

B\u1ed5 sung s\u1eaft sucrose t\u0129nh m\u1ea1ch : L \u1ecd 5 ml ch\u1ee9a 100 mg<\/p>\n

    \n
  • Li\u1ec1u ti\u00eau chu\u1ea9n: 200 mg (2 l\u1ecd, 10 ml)<\/li>\n
  • Li\u1ec1u test nh\u1ecf: L i\u1ec1u \u0111\u1ea7u ti\u00eam 2 ml , sau \u0111\u00f3 8 ml c\u00f2n l\u1ea1i sau 10 ph\u00fat Khi kh\u00f4ng pha lo\u00e3ng v\u00e0 ti\u00eam ch\u1eadm h\u01a1n 10 ph\u00fat t\u01b0\u01a1ng \u0111\u1ed1i an to\u00e0n.<\/li>\n<\/ul>\n

    C\u00e1c l\u1ea7n sau \u0111\u00f3 kh\u00f4ng c\u1ea7n li\u1ec1u test l\u1ea1i .<\/p>\n

    Da<\/strong><\/p>\n

      \n
    • Th\u01b0\u1eddng g\u1eb7p t\u00ecnh tr\u1ea1ng m\u1ee5n t\u01b0\u01a1ng \u0111\u1ed1i n\u1eb7ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n tim b\u1ea9m sinh c\u00f3 t\u00edm<\/li>\n
    • M\u1ee5n ngo\u00e0i da c\u00f3 th\u1ec3 l\u00e0 ngu\u1ed3n g\u1ed1c c\u1ee7a nhi\u1ec5m tr\u00f9ng v\u00e0 vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/li>\n
    • C\u1ea7n kh\u00e1m \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c t\u1ea1i chuy\u00ean khoa da li\u1ec5u<\/li>\n<\/ul>\n

      S\u1ecfi m\u1eadt<\/strong><\/p>\n

        \n
      • Hay g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n tim b\u1ea9m sinh c\u00f3 t\u00edm<\/li>\n
      • Bilirubin l\u00e0 s\u1ea3n ph\u1ea9m c\u1ee7a gi\u00e1ng h\u00f3a c\u1ee7a Hemoglobin<\/li>\n
      • C\u1ea7n \u0111\u1eb7t ch\u1ea9n \u0111o\u00e1n nghi ng\u1edd n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111au b\u1ee5ng\/\u0111\u1ea7y b\u1ee5ng.<\/li>\n<\/ul>\n

        Ch\u1ee9c n\u0103ng th\u1eadn<\/strong><\/p>\n

        Gi\u1ea3m m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn T\u0103ng creatinin m\u00e1u<\/p>\n

        B\u1ec7nh nh\u00e2n t\u00edm m\u1ea1n t\u00ednh th\u01b0\u1eddng gi\u1ea3m kh\u1ea3 n\u0103ng th\u1ea3i acid uric, c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n th\u00e0nh b\u1ec7nh gout<\/p>\n

        Ch\u00fa \u00fd khi s\u1eed d\u1ee5ng thu\u1ed1c c\u1ea3n quang \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, truy\u1ec1n d\u1ecbch tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c<\/p>\n

        2. Ph\u1eabu thu\u1eadt ngo\u00e0i tim<\/h2>\n

        N\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh t\u1ea1i c\u00e1c trung t\u00e2m chuy\u00ean khoa v\u00e0 \u0111a chuy\u00ean ng\u00e0nh.<\/p>\n

        N\u1ebfu kh\u00f4ng c\u00f3 b\u00e1c s\u0129 g\u00e2y m\u00ea tim m\u1ea1ch c\u00f3 kinh nghi\u1ec7m v\u1edbi b\u1ec7nh l\u00fd tim b\u1ea9m sinh, l\u1ef1a ch\u1ecdn v\u00f4 c\u1ea3m b\u1eb1ng g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 ho\u1eb7c g\u00e2y t\u00ea tu\u1ef7 s\u1ed1ng n\u1ebfu c\u00f3 th\u1ec3<\/p>\n

        Xem x\u00e9t r\u00fat m\u00e1u tr\u01b0\u1edbc m\u1ed5 n\u1ebfu Hb > 20 g \/dL ho\u1eb7c Hct > 65%<\/p>\n

        N\u00ean s\u1eed d\u1ee5ng m\u00e0ng l\u1ecdc kh\u00ed<\/p>\n

        3. Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng<\/h2>\n

        Theo khuy\u1ebfn c\u00e1o c\u1ee7a ESC v\u1ec1 vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n (VNTMNK) n\u0103m 2015, kh\u00e1ng sinh d\u1ef1 ph\u00f2ng n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t cho b\u1ec7nh nh\u00e2n \u1edf m\u1ee9c nguy c\u01a1 cao \u0111\u1ed1i v\u1edbi VNTMNK, bao g\u1ed3m:<\/p>\n

          \n
        • B\u1ec7nh nh\u00e2n v\u1edbi b\u1ea5t k\u1ef3 van nh\u00e2n t\u1ea1o n\u00e0o, bao g\u1ed3m c\u1ea3 van nh\u00e2n t\u1ea1o \u0111\u1eb7t qua \u1ed1ng th\u00f4ng ho\u1eb7c \u0111\u01b0\u1ee3c s\u1eeda van v\u1edbi v\u1eadt li\u1ec7u nh\u00e2n t\u1ea1o.<\/li>\n
        • B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed VNTMNK<\/li>\n
        • B\u1ec7nh nh\u00e2n tim b\u1ea9m sinh lo\u1ea1i: (1) tim b\u1ea9m sinh c\u00f3 t\u00edm; (2) tim b\u1ea9m sinh c\u00f3 v\u1eadt li\u1ec7u nh\u00e2n t\u1ea1o, c\u00f3 th\u1ec3 qua ph\u0201u thu\u1eadt ho\u1eb7c can thi\u1ec7p qua da. Li\u1ec7u tr\u00ecnh kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho \u0111\u1ebfn 6 th\u00e1ng sau th\u1ee7 thu\u1eadt, ho\u1eb7c su\u1ed1t \u0111\u1eddi n\u1ebfu c\u00f2n shunt t\u1ed3n l\u01b0u ho\u1eb7c h\u1edf van tim.<\/li>\n<\/ul>\n

          B\u1ec7nh nh\u00e2n c\u1ea7n ch\u00fa \u00fd gi\u1eef v\u1ec7 sinh r\u0103ng mi\u1ec7ng t\u1ed1t.<\/p>\n

          \"Qu\u1ea3n<\/p>\n

          Qu\u1ea3n l\u00fd b\u1ec7nh tim b\u1ea9m sinh<\/strong><\/p>\n

          4. R\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/h2>\n

          R\u1ed1i lo\u1ea1n nh\u1ecbp l\u00e0 nguy\u00ean nh\u00e2n quan tr\u1ecdng l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 l\u00e0m n\u1eb7ng b\u1ec7nh; c\u0169ng l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh c\u1ea7n nh\u1eadp vi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n tim b\u1ea9m sinh. R\u1ed1i lo\u1ea1n nh\u1ecbp tim l\u00e0 t\u00ecnh tr\u1ea1ng k\u00e9m dung n\u1ea1p v\u00e0 c\u00f3 th\u1ec3 g\u00e2y r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng.<\/p>\n

          Nguy\u00ean nh\u00e2n r\u1ed1i lo\u1ea1n nh\u1ecbp tim:<\/p>\n

            \n
          • D o b\u1ea5t th\u01b0\u1eddng gi\u1ea3i ph\u0201u tim.<\/li>\n
          • Di\u1ec5n bi\u1ebfn t\u1ef1 nhi\u00ean c\u1ee7a b\u1ec7nh: Do thay \u0111\u1ed5i v\u1ec1 huy\u1ebft \u0111\u1ed9ng g\u00e2y ra gi\u00e3n ho\u1eb7c s\u1eb9o h\u00f3a c\u01a1 tim.<\/li>\n
          • C\u00e1c b \u1ea5t th\u01b0\u1eddng t\u1ed3n d\u01b0 sau m\u1ed5.<\/li>\n<\/ul>\n

            X\u1eed tr\u00ed:<\/strong><\/p>\n

              \n
            • R\u1ed1i lo\u1ea1n nh\u1ecbp tim m\u1edbi xu\u1ea5t hi\u1ec7n c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 huy\u1ebft \u0111\u1ed9ng v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111i\u1ec7n sinh l\u00fd . \u0110\u00f4i khi, \u0111\u1ea3o ng\u01b0\u1ee3c c\u00e1c bi\u1ebfn \u0111\u1ed5i huy\u1ebft \u0111\u1ed9ng sau m\u1ed5 \u0111\u00e3 c\u00f3 th\u1ec3 kh\u1eafc ph\u1ee5c \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n nh\u1ecbp v\u00e0 l\u00e0 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb quan tr\u1ecdng nh\u1ea5t.<\/li>\n
            • Ghi \u0111i\u1ec7n t \u00e2m \u0111\u1ed3 12 chuy\u1ec3n \u0111\u1ea1o \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n r\u1ed1i lo\u1ea1n nh\u1ecbp. Ch\u1ec9 \u0111\u1ecbnh holter 24h n\u1ebfu r\u1ed1i lo\u1ea1n nh\u1ecbp ph\u1ee9c t\u1ea1p.<\/li>\n
            • C\u00f3 th\u1ec3 ti\u00eam t\u0129nh m\u1ea1ch adenosine \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t c \u00e1c c\u01a1n nh \u1ecbp tim nhanh. Adenosine r\u1ea5t hi\u1ec7u qu\u1ea3 \u0111\u1ec3 c\u1eaft c\u01a1n nh\u1ecbp nhanh k\u1ecbch ph\u00e1t tr\u00ean th\u1ea5t.<\/li>\n<\/ul>\n

              N\u1ebfu c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp tim g\u00e2y r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng c\u1ea7n chuy\u1ec3n nh\u1ecbp c\u1ea5p c\u1ee9u, d \u00f9ng s\u1ed1c \u0111i\u1ec7n ho\u1eb7c thu\u1ed1c chuy\u1ec3n nh\u1ecbp . Trong tr \u01b0\u1eddng h\u1ee3p rung nh\u0129 nhanh, t \u1ed1t nh\u1ea5t c\u1ea7n si\u00eau \u00e2m qua th\u1ef1c qu\u1ea3n \u0111\u1ec3 lo\u1ea1i tr\u1eeb huy\u1ebft kh\u1ed1i bu\u1ed3ng tim tr\u01b0\u1edbc khi chuy\u1ec3n nh\u1ecbp tim v\u1ec1 xoang . N\u1ebfu b\u1ec7nh nh\u00e2n \u0111ang u\u1ed1ng warfarin, c\u1ea7n x\u00e9t nghi\u1ec7m PT-INR v\u00e0 \u0111i\u1ec7n gi\u1ea3i m\u00e1u tr\u01b0\u1edbc khi chuy\u1ec3n nh\u1ecbp tim.<\/p>\n

              5. K\u1ebft lu\u1eadn<\/h2>\n

              B\u1ec7nh nh\u00e2n tim b\u1ea9m sinh c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i v\u00e0 ch\u0103m s\u00f3c \u0111\u1ecbnh k\u1ef3 \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ee9c kh\u1ecfe \u0111\u01b0\u1ee3c gi\u1eef v\u1eefng v\u00e0 c\u1ea3i thi\u1ec7n n\u1ebfu c\u00f3 th\u1ec3. C\u00e1c chuy\u00ean gia y t\u1ebf s\u1ebd theo d\u00f5i s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a b\u1ec7nh v\u00e0 \u0111\u01b0a ra c\u00e1c ch\u1ec9 d\u1eabn \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nh\u1eefng v\u1ea5n \u0111\u1ec1 c\u00f3 th\u1ec3 x\u1ea3y ra.<\/p>\n","protected":false},"excerpt":{"rendered":"

              Qu\u1ea3n l\u00fd b\u1ec7nh tim b\u1ea9m sinh \u0111\u00f2i h\u1ecfi li\u00ean t\u1ee5c t\u1eeb c\u00e1c chuy\u00ean gia y t\u1ebf, b\u1ec7nh nh\u00e2n v\u00e0 gia \u0111\u00ecnh. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 v\u1ea5n \u0111\u1ec1 qu\u1ea3n l\u00fd b\u1ec7nh tim b\u1ea9m sinh c\u1ea7n \u0111\u01b0\u1ee3c quan t\u00e2m: 1. Bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh tim b\u1ea9m sinh c\u00f3 t\u00edm Thi\u1ebfu oxy m\u1ea1n t\u00ednh d\u1ea7n \u0111\u1ebfn t\u0103ng […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nQu\u1ea3n l\u00fd b\u1ec7nh tim b\u1ea9m sinh - Vinmec<\/title>\n<meta name=\"description\" content=\"Qu\u1ea3n l\u00fd b\u1ec7nh tim b\u1ea9m sinh \u0111\u00f2i li\u00ean t\u1ee5c t\u1eeb c\u00e1c chuy\u00ean gia y t\u1ebf, b\u1ec7nh nh\u00e2n v\u00e0 gia \u0111\u00ecnh, g\u1ed3m: Bi\u1ebfn ch\u1ee9ng b\u1ec7nh tim c\u00f3 t\u00edm, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c\" \/>\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=\"Qu\u1ea3n l\u00fd b\u1ec7nh tim b\u1ea9m sinh - 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