{"id":32544,"date":"2023-05-07T16:48:39","date_gmt":"2023-05-07T09:48:39","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32544"},"modified":"2023-05-07T16:48:39","modified_gmt":"2023-05-07T09:48:39","slug":"benh-tim-bam-sinh-va-cac-bien-chung-ngoai-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/benh-tim-bam-sinh-va-cac-bien-chung-ngoai-tim\/","title":{"rendered":"B\u1ec7nh tim b\u1ea9m sinh v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng ngo\u00e0i tim"},"content":{"rendered":"
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B\u1ec7nh tim b\u1ea9m sinh<\/a> c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng ngo\u00e0i tim, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c c\u1ee7a b\u1ec7nh, c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang c\u00e1ch c\u1ea7n \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 gi\u00fap b\u1ea3o v\u1ec7 s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh tim b\u1ea9m sinh. \u0110\u1ed3ng th\u1eddi, c\u1ea7n ph\u1ea3i theo d\u00f5i ch\u1eb7t ch\u1ebd t\u00ecnh tr\u1ea1ng\u00a0 v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng ngo\u00e0i tim k\u1ecbp th\u1eddi \u0111\u1ec3 ng\u0103n ng\u1eeba t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd tr\u1ea7m tr\u1ecdng h\u01a1n.<\/strong><\/p>\n

1. Gi\u1edbi thi\u1ec7u<\/h2>\n

B\u1ec7nh tim b\u1ea9m sinh c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng ngo\u00e0i tim, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c c\u1ee7a b\u1ec7nh, c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang c\u00e1ch c\u1ea7n \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 gi\u00fap b\u1ea3o v\u1ec7 s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh tim b\u1ea9m sinh.<\/strong><\/p>\n

2. C\u00e1c bi\u1ebfn ch\u1ee9ng ngo\u00e0i tim<\/h2>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

2.1.T\u00ecnh tr\u1ea1ng \u0111a h\u1ed3ng c\u1ea7u<\/h3>\n

Nguy\u00ean nh\u00e2n: <\/strong>Thi\u1ebfu oxy m\u1ea1n t\u00ednh k\u00edch th\u00edch s\u1ea3n xu\u1ea5t erythropoietin v\u00e0 h\u1ed3ng c\u1ea7u.<\/p>\n

\u0110i\u1ec1u tr\u1ecb r\u00fat m\u00e1u t\u0129nh m\u1ea1ch:<\/p>\n

    \n
  • Khuy\u1ebfn c\u00e1o duy tr\u00ec m\u1ee9c hemoglobin l\u00fd t\u01b0\u1edfng l\u00e0 17 – 18 g\/dL<\/li>\n
  • R\u00fat m\u00e1u t\u0129nh m\u1ea1ch: V\u1edbi m\u1ee5c \u0111\u00edch ki\u1ec3m so\u00e1t hematocrit v\u00e0 ng\u0103n ng\u1eeba h\u1ed9i ch\u1ee9ng c\u00f4 \u0111\u1eb7c m\u00e1u<\/li>\n<\/ul>\n

    Ch\u1ec9 \u0111\u1ecbnh<\/strong>: Xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng c\u00f4 \u0111\u1eb7c m\u00e1u v\u00e0 hematocrit > 65% ho\u1eb7c Hb > 20 g \/dL<\/p>\n

    K\u1ef9 thu\u1eadt: R\u00fat t\u1ed1i \u0111a 500 mL m\u00e1u trong v\u00f2ng 30 – 45 ph\u00fat \u0111\u1ed3ng th\u1eddi truy\u1ec1n thay th\u1ebf th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n b\u1eb1ng 500 – 1000 mL mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng, ho\u1eb7c glucose (n\u1ebfu suy tim). L\u01b0u \u00fd: Tr\u00e1nh thay \u0111\u1ed5i \u0111\u1ed9t ng\u1ed9t th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n g\u00e2y t\u1ee5t huy\u1ebft \u00e1p.<\/p>\n

    N\u1ebfu c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u0103ng \u0111\u1ed9 nh\u1edbt l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a m\u1ea5t n\u01b0\u1edbc c\u1ea5p t\u00ednh ho\u1eb7c thi\u1ebfu s\u1eaft, kh\u00f4ng r\u00fat m\u00e1u m\u00e0 b\u00f9 d\u1ecbch v\u00e0\/ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1ed5 sung s\u1eaft.<\/p>\n

    \"B\u1ec7nh<\/p>\n

    B\u1ec7nh tim b\u1ea9m sinh v\u00e0 bi\u1ebfn ch\u1ee9ng \u0111a h\u1ed3ng c\u1ea7u<\/strong><\/p>\n

    2.2. B\u1ec7nh th\u1eadn v\u00e0 b\u1ec7nh gout<\/h3>\n

    Nguy\u00ean nh\u00e2n: <\/strong>Thi\u1ebfu oxy \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng c\u1ee7a c\u1ea7u th\u1eadn v\u00e0 \u1ed1ng th\u1eadn, d\u0201n \u0111\u1ebfn protein ni\u1ec7u, gi\u1ea3m b\u00e0i ti\u1ebft urat, t\u0103ng t\u00e1i h\u1ea5p thu urat, v\u00e0 gi\u1ea3m \u0111\u1ed9 thanh th\u1ea3i creatinin. Tuy nhi\u00ean, \u00edt g\u1eb7p h\u1eadu qu\u1ea3 suy th\u1eadn n\u1eb7ng.<\/p>\n

    \u0110i\u1ec1u tr\u1ecb:<\/strong><\/p>\n

    Tr\u00e1nh m\u1ea5t n\u01b0\u1edbc, l\u01b0u \u00fd khi d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 thu\u1ed1c c\u1ea3n quang. T\u0103ng axit uric kh\u00f4ng tri\u1ec7u ch\u1ee9ng kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb.<\/p>\n

    C\u01a1n g\u00fat c\u1ea5p t\u00ednh: Colchicine v\u00e0 steroid l\u00e0 l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u. N\u00ean tr\u00e1nh s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAID).<\/p>\n

    2.3. Nhi\u1ec5m tr\u00f9ng huy\u1ebft<\/h3>\n

    B\u1ec7nh nh\u00e2n d\u1ec5 b\u1ecb nhi\u1ec5m tr\u00f9ng. M\u1ee5n tr\u1ee9ng c\u00e1 kh\u00e1 ph\u1ed5 bi\u1ebfn, kh\u1ea3 n\u0103ng l\u00e0nh s\u1eb9o k\u00e9m. B\u1ea5t k\u1ef3 m\u1ed9t v\u1ecb tr\u00ed nhi\u1ec5m tr\u00f9ng ban \u0111\u1ea7u n\u00e0o tr\u00ean c\u01a1 th\u1ec3 \u0111\u1ec1u c\u00f3 th\u1ec3 d\u0201n \u0111\u1ebfn \u00e1p xe n\u00e3o do \u1ed5 di b\u1ec7nh ho\u1eb7c thuy\u00ean t\u1eafc nhi\u1ec5m khu\u1ea9n.<\/p>\n

    D\u1ef1 ph\u00f2ng:<\/strong><\/p>\n

    C\u00e1c v\u1ebft th\u01b0\u01a1ng kh\u00e2u da sau c\u00e1c ph\u0201u thu\u1eadt m\u1edf n\u00ean c\u1eaft ch\u1ec9 mu\u1ed9n h\u01a1n b\u00ecnh th\u01b0\u1eddng, kho\u1ea3ng sau 7-10 ng\u00e0y.<\/p>\n

    L\u01b0u \u00fd v\u1ec7 sinh r\u0103ng mi\u1ec7ng (nguy c\u01a1 vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng v\u00e0o t\u1eeb r\u0103ng mi\u1ec7ng \u1edf nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y cao).<\/p>\n

    2.4. Huy\u1ebft kh\u1ed1i v\u00e0 ch\u1ea3y m\u00e1u<\/h3>\n

    Do nhi\u1ec1u y\u1ebfu t\u1ed1: <\/strong>b\u1ea5t th\u01b0\u1eddng ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u, b\u1ea5t th\u01b0\u1eddng \u0111\u00f4ng m\u00e1u v\u00e0 \u0111a h\u1ed3ng c\u1ea7u. Th\u1eddi gian prothrombin (PT) v\u00e0 th\u1eddi gian thromboplastin t\u1eebng ph\u1ea7n ho\u1ea1t h\u00f3a (aPTT) c\u00f3 th\u1ec3 t\u0103ng do gi\u1ea3m c\u00e1c y\u1ebfu t\u1ed1 V, VII, VIII v\u00e0 X.<\/p>\n

    Tri\u1ec7u ch\u1ee9ng: <\/strong>huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch, huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch v\u00e0 bi\u1ebfn ch\u1ee9ng xu\u1ea5t huy\u1ebft (v\u00ed d\u1ee5: ban xu\u1ea5t huy\u1ebft, ch\u1ea3y m\u00e1u m\u0169i, ho m\u00e1u) \u0111\u1ec1u c\u00f3 th\u1ec3 x\u1ea3y ra. M\u1ea5t n\u01b0\u1edbc ho\u1eb7c u\u1ed1ng thu\u1ed1c tr\u00e1nh thai l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y huy\u1ebft kh\u1ed1i.<\/p>\n

    \u0110i\u1ec1u tr\u1ecb:<\/strong><\/p>\n

    Ch\u1ea3y m\u00e1u t\u1ef1 ph\u00e1t ph\u1ea7n l\u1edbn t\u1ef1 c\u1ea7m.<\/p>\n

    Trong tr\u01b0\u1eddng h\u1ee3p ch\u1ea3y m\u00e1u nghi\u00eam tr\u1ecdng, c\u00e1c bi\u1ec7n ph\u00e1p chung c\u00f3 hi\u1ec7u qu\u1ea3, bao g\u1ed3m truy\u1ec1n ti\u1ec3u c\u1ea7u, huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i \u0111\u00f4ng l\u1ea1nh (FFP), t\u1ee7a l\u1ea1nh v\u00e0 vitamin K.<\/p>\n

    N\u00ean tr\u00e1nh d\u00f9ng Aspirin v\u00e0 c\u00e1c NSAID kh\u00e1c \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 ch\u1ea3y m\u00e1u t\u1ef1 ph\u00e1t.<\/p>\n

    2.5. <\/strong>C\u00e1c v\u1ea5n \u0111\u1ec1 \u1edf ph\u1ed5i<\/h3>\n

    Bao g\u1ed3m nhi\u1ec5m tr\u00f9ng, nh\u1ed3i m\u00e1u v\u00e0 xu\u1ea5t huy\u1ebft do v\u1ee1 c\u00e1c ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c mao m\u1ea1ch.<\/p>\n

    2.6. \u0110\u1ed9t qu\u1ef5<\/h3>\n

    C\u00f3 th\u1ec3 l\u00e0 \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n \u00e3o v\u00e0\/ho \u1eb7c \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n \u00e3o<\/p>\n

    Nguy\u00ean nh\u00e2n:<\/p>\n

    Huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch, t\u1eafc m\u1ea1ch (t\u1eafc m\u1ea1ch ngh\u1ecbch th\u01b0\u1eddng do shunt ph\u1ea3i – tr\u00e1i) v\u00e0 r\u00fat m\u00e1u kh\u00f4ng \u0111\u00fang c\u00e1ch \u0111\u1ec1u d\u0201n \u0111\u1ebfn huy\u1ebft kh\u1ed1i t\u1ef1 ph\u00e1t.<\/p>\n

    V\u1ea5n \u0111\u1ec1 c\u1ea7m m\u00e1u, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi k\u1ebft h\u1ee3p v\u1edbi NSAID ho\u1eb7c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u, c\u00f3 th\u1ec3 d\u0201n \u0111\u1ebfn xu\u1ea5t huy\u1ebft.<\/p>\n

    T\u1ea5t c\u1ea3 c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u1edf n\u00e3o \u0111\u1ec1u c\u00f3 th\u1ec3 tr\u1edf th\u00e0nh \u1ed5 nhi\u1ec5m tr\u00f9ng n\u1ed9i s\u1ecd \/ h\u00ecnh th\u00e0nh \u00e1p xe.<\/p>\n

    2.7. Bi\u1ebfn ch\u1ee9ng th\u1ee9 ph\u00e1t li\u00ean quan t\u1edbi thu\u1ed1c, c\u00e1c th\u0103m d\u00f2 v\u00e0 ph\u1eabu thu\u1eadt<\/h3>\n

    Tr\u00e1nh thay \u0111\u1ed5i \u0111\u1ed9t ng\u1ed9t huy\u1ebft \u00e1p ho\u1eb7c s\u1ee9c c\u1ea3n h\u1ec7 th\u1ed1ng.<\/p>\n

    C\u00e1c thu\u1ed1c c\u1ea3n quang c\u00f3 th\u1ec3 g\u00e2y ph\u1ea3n x\u1ea1 gi\u00e3n m\u1ea1ch h\u1ec7 th\u1ed1ng , tr\u1ee5y m\u1ea1ch c\u1ea5p t\u00ednh. Thu\u1ed1c c\u0169ng c\u00f3 th\u1ec3 k\u1ebft t\u1ee7a g\u00e2y suy th\u1eadn.<\/p>\n

    Tr\u01b0\u1edbc c\u00e1c ph\u0201u thu\u1eadt ngo\u00e0i tim, c\u1ed1 g\u1eafng t\u1ed1i \u01b0u h\u00f3a n\u1ed3ng \u0111\u1ed9 hematocrit b\u1eb1ng r\u00fat m\u00e1u ch\u1ee7 \u0111\u1ed9ng v\u00e0 thay th\u1ebf b\u1eb1ng dung d\u1ecbch dextran. Li\u1ec7u ph\u00e1p oxy l\u01b0u l\u01b0\u1ee3ng cao r\u1ea5t quan tr\u1ecdng tr\u01b0\u1edbc v\u00e0 sau ph\u0201u thu\u1eadt.<\/p>\n

    \u0110 \u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch cho c\u00e1c b\u1ec7nh nh\u00e2 n c\u1ea7n \u0111\u1eb7c bi\u1ec7t ch\u00fa \u00fd<\/p>\n

    2.8. \u0110au kh\u1edbp<\/h3>\n

    Ch\u1ee7 y\u1ebfu do b\u1ec7nh x\u01b0\u01a1ng kh\u1edbp ph\u00ec \u0111\u1ea1i. \u1ede b\u1ec7nh nh\u00e2n c\u00f3 shunt ph\u1ea3i – tr\u00e1i, t\u1ebf b\u00e0o nh\u00e2n kh\u1ed5ng l\u1ed3 kh\u00f4ng \u0111i qua tu\u1ea7n ho\u00e0n ph\u1ed5i m\u00e0 \u1edf l\u1ea1i trong c\u00e1c m\u1ea1ch m\u00e1u h\u1ec7 th\u1ed1ng, th\u00fac \u0111\u1ea9y s\u1ef1 t\u00e2n t\u1ea1o x\u01b0\u01a1ng m\u1edbi, c\u0169ng c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn t\u0103ng acid uric m\u00e1u.<\/p>\n

    2.9. Ho m\u00e1u<\/h3>\n

    L\u00e0 bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p, hay g\u1eb7p sau nhi\u1ec5m tr\u00f9ng nh\u01b0ng th\u01b0\u1eddng t\u1ef1 c\u1ea7m. Kh\u00e1 kh\u00f3 \u0111\u1ec3 ph\u00e2n bi\u1ec7t v\u1edbi t\u1eafc m\u1ea1ch ph\u1ed5i tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n

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

    Gi\u1eef cho b\u1ec7nh nh\u00e2n y\u00ean t\u0129nh v\u00e0 \u0111\u1ea3m b\u1ea3o huy\u1ebft \u00e1p. Th\u1edf oxy l\u01b0u l\u01b0\u1ee3ng cao qua mask.<\/p>\n

    N\u1ebfu l\u00e2m s\u00e0ng c\u00f3 nghi ng\u1edd nhi\u1ec5m tr\u00f9ng (s\u1ed1t, ho \u0111\u1eddm, t\u0103ng b\u1ea1ch c\u1ea7u, t\u0103ng protein ph\u1ea3n \u1ee9ng C (CRP), v.v.) th\u00ec b\u1eaft \u0111\u1ea7u d\u00f9ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng.<\/p>\n

    C\u00f3 th\u1ec3 \u0111o th\u00f4ng kh\u00ed t\u01b0\u1edbi m\u00e1u (V\/Q) gi\u00fap ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc ph\u1ed5i nh\u01b0ng th\u01b0\u1eddng kh\u00f4ng r\u00f5 r\u00e0ng.<\/p>\n

    Tr\u00e1nh d\u00f9ng aspirin v\u00e0 nh\u00f3m NSAID v\u00ec nh\u1eefng thu\u1ed1c n\u00e0y l\u00e0m gi\u1ea3m ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u.<\/p>\n

    M\u1ed9t v\u00e0i b\u1eb1ng ch\u1ee9ng y h\u1ecdc cho vi\u1ec7c s\u1eed d\u1ee5ng heparin t\u0129nh m\u1ea1ch li\u1ec1u th\u1ea5p pha trong dextran 40 (truy\u1ec1n t\u0129nh m\u1ea1ch 500ml trong 4 – 6h), Arvin\u00ae (l\u00e0m gi\u1ea3m fibrinogen huy\u1ebft t\u01b0\u01a1ng b\u1eb1ng c\u00e1ch c\u1eaft \u0111o\u1ea1n fibrin), ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng warfarin li\u1ec1u th\u1ea5p \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 huy\u1ebft kh\u1ed1i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n

    Xu\u1ea5t huy\u1ebft ph\u1ed5i n\u1eb7ng c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi aprotinin ho\u1eb7c axit tranexamic.<\/p>\n

    2.10. Kh\u00f3 th\u1edf<\/h3>\n

    Nguy\u00ean nh\u00e2n: <\/strong>C\u00f3 th\u1ec3 l\u00e0 do ph\u00f9 ph\u1ed5i ho\u1eb7c thi\u1ebfu oxy (t\u0103ng shunt) th\u1ee9 ph\u00e1t sau vi\u00eam ph\u1ed5i ho\u1eb7c thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n

    \u0110\u00e1nh gi\u00e1:<\/strong><\/p>\n

    So s\u00e1nh v\u1edbi c\u00e1c phim X-Quang ng\u1ef1c tr\u01b0\u1edbc \u0111\u00f3, \u0111\u00e1nh gi\u00e1 b\u1eb1ng ch\u1ee9ng ph\u00f9 ph\u1ed5i.<\/p>\n

    \u00c1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1ea3nh (JVP) \u1edf b\u1ec7nh nh\u00e2n tim b\u1ea9m sinh c\u00f3 t\u00edm th\u01b0\u1eddng cao v\u00e0 kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n suy tim. Nh\u00ecn chung, b\u1ec7nh nh\u00e2n c\u1ea7n \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y cao h\u01a1n \u0111\u1ec3 duy tr\u00ec l\u01b0u l\u01b0\u1ee3ng m\u00e1u ph\u1ed5i.<\/p>\n

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

      \n
    • Th\u1edf oxy l\u01b0u l\u01b0\u1ee3ng cao qua mask.<\/li>\n
    • B\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng kh\u00e1ng sinh n\u1ebfu c\u00f3 nghi ng\u1edd nhi\u1ec5m tr\u00f9ng tr\u00ean l\u00e2m s\u00e0ng.<\/li>\n
    • D\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u n\u1ebfu c\u00f3 b\u1eb1ng ch\u1ee9ng ph\u00f9 ph\u1ed5i ho\u1eb7c suy tim ph\u1ea3i n\u1eb7ng. Theo d\u00f5i hematocrit v\u00e0 ch\u1ee9c n\u0103ng th\u1eadn ch\u1eb7t ch\u1ebd \u0111\u1ec3 t\u00ecm d\u1ea5u hi\u1ec7u c\u1ee7a qu\u00e1 li\u1ec1u l\u1ee3i ti\u1ec3u.<\/li>\n
    • Kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u ho\u1eb7c nitrat li\u1ec1u cao c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c h\u1ec7 th\u1ed1ng g\u00e2y tr\u1ee5y m\u1ea1ch c\u1ea5p t\u00ednh.<\/li>\n<\/ul>\n

      2.11. Ng\u1ea5t<\/h3>\n

      Nguy\u00ean nh\u00e2n: R\u1ed1i lo\u1ea1n nh\u1ecbp tim, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1ecbp nhanh th\u1ea5t (VT) (theo d\u00f5i Holter \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 ), b\u1ec7nh van tim n\u1eb7ng, ho\u1eb7c d\u1ea5u hi\u1ec7u suy tim n\u1eb7ng.<\/p>\n

      \u0110i\u1ec1u tr\u1ecb theo nguy\u00ean nh\u00e2n.<\/p>\n

      2.12. \u0110au ng\u1ef1c<\/h3>\n

      Nguy\u00ean nh\u00e2n: Th\u1ee9 ph\u00e1t sau thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i ho\u1eb7c nh\u1ed3i m\u00e1u ph\u1ed5i (huy\u1ebft kh\u1ed1i t\u1ef1 ph\u00e1t), vi\u00eam ph\u1ed5i, b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, ho\u1eb7c nguy\u00ean nh\u00e2n c\u01a1 x\u01b0\u01a1ng kh\u1edbp.<\/p>\n

      \u0110\u00e1nh gi\u00e1 chi ti\u1ebft \u0111\u1ec3 t\u00ecm nguy\u00ean nh\u00e2n.<\/p>\n

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

      B\u1ec7nh tim b\u1ea9m sinh c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng ngo\u00e0i tim, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c c\u1ee7a b\u1ec7nh, c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang c\u00e1ch c\u1ea7n \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 gi\u00fap b\u1ea3o v\u1ec7 s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh tim b\u1ea9m sinh.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

      B\u1ec7nh tim b\u1ea9m sinh c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng ngo\u00e0i tim, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n. \u0110\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c c\u1ee7a b\u1ec7nh, c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang c\u00e1ch c\u1ea7n \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 gi\u00fap b\u1ea3o v\u1ec7 s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh tim b\u1ea9m […]<\/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":"\nB\u1ec7nh tim b\u1ea9m sinh v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng ngo\u00e0i tim - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh tim b\u1ea9m sinh g\u00e2y bi\u1ebfn ch\u1ee9ng ngo\u00e0i tim, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c kh\u1ecfe, c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u00fang gi\u00fap b\u1ea3o v\u1ec7 s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n.\" \/>\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=\"B\u1ec7nh tim b\u1ea9m sinh v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng ngo\u00e0i tim - 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