{"id":32890,"date":"2023-05-14T19:24:49","date_gmt":"2023-05-14T12:24:49","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32890"},"modified":"2023-05-14T19:24:49","modified_gmt":"2023-05-14T12:24:49","slug":"tang-huyet-ap-o-phu-nu-co-thai","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/14\/tang-huyet-ap-o-phu-nu-co-thai\/","title":{"rendered":"T\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef c\u00f3 thai"},"content":{"rendered":"

T\u0103ng huy\u1ebft \u00e1p<\/a> g\u1eb7p \u1edf 5 – 10% ph\u1ee5 n\u1eef mang thai tr\u00ean th\u1ebf gi\u1edbi, \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh l\u00fd tim m\u1ea1ch h\u00e0ng \u0111\u1ea7u l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong cho m\u1eb9, thai nhi v\u00e0 tr\u1ebb s\u01a1 sinh. Nguy c\u01a1 c\u1ee7a m\u1eb9 bao g\u1ed3m rau bong non, \u0111\u1ed9t qu\u1ef5, suy \u0111a t\u1ea1ng, t\u1eed vong chu s\u1ea3n. Thai nhi c\u00f3 nguy c\u01a1 cao b\u1ecb ch\u1eadm ph\u00e1t tri\u1ec3n trong bu\u1ed3ng t\u1eed cung, sinh non v\u00e0 thai l\u01b0u, v\u1edbi t\u1ef7 l\u1ec7 l\u1ea7n l\u01b0\u1ee3t l\u00e0 25%, 27% v\u00e0 4% tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n ti\u1ec1n s\u1ea3n gi\u1eadt.<\/strong><\/p>\n

\"T\u0103ng<\/p>\n

T\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef c\u00f3 thai<\/strong><\/p>\n

1.\u0110\u1ecbnh ngh\u0129a<\/h2>\n

\u0110\u1ecbnh ngh\u0129a t\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef c\u00f3 thai ch\u1ec9 d\u1ef1a v\u00e0o ch\u1ec9 s\u1ed1 huy\u1ebft \u00e1p \u0111o t\u1ea1i b\u1ec7nh vi\u1ec7n (ho\u1eb7c ph\u00f2ng kh\u00e1m) v\u1edbi huy\u1ebft \u00e1p t\u00e2m thu \u2265 140 mmHg v\u00e0\/ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng \u2265 90 mmHg.<\/p>\n

T\u0103ng huy\u1ebft \u00e1p nh\u1eb9 khi huy\u1ebft \u00e1p t\u00e2m thu t\u1eeb 140 – 159 mmHg v\u00e0\/ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng t\u1eeb 90 – 109 mmHg.<\/p>\n

T\u0103ng huy\u1ebft \u00e1p n\u1eb7ng khi huy\u1ebft \u00e1p t\u00e2m thu \u2265 160 mmHg v\u00e0\/ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng \u2265 110 mmHg.<\/p>\n

Ph\u00e2n lo\u1ea1i t\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef c\u00f3 thai g\u1ed3m 4 lo\u1ea1i nh\u01b0 sau:<\/p>\n

T\u0103ng huy\u1ebft \u00e1p c\u00f3 t\u1eeb tr\u01b0\u1edbc <\/strong>: Huy\u1ebft \u00e1p \u2265 140\/90 mmHg t\u1eeb tr\u01b0\u1edbc khi mang thai ho\u1eb7c ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc tu\u1ea7n 20 c\u1ee7a thai k\u1ef3, th\u01b0\u1eddng k\u00e9o d\u00e0i qu\u00e1 42 ng\u00e0y sau \u0111\u1ebb v\u00e0 c\u00f3 th\u1ec3 k\u00e8m theo protein ni\u1ec7u. T\u1ef7 l\u1ec7 g\u1eb7p kho\u1ea3ng 1 – 5%.<\/p>\n

T\u0103ng huy\u1ebft \u00e1p thai ngh\u00e9n <\/strong>: T\u0103ng huy\u1ebft \u00e1p xu\u1ea5t hi\u1ec7n sau tu\u1ea7n th\u1ee9 20 c\u1ee7a thai k\u1ef3, c\u00f3 th\u1ec3 k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m protein ni\u1ec7u nh\u01b0ng kh\u00f4ng k\u00e8m c\u00e1c d\u1ea5u hi\u1ec7u ho\u1eb7c tri\u1ec7u ch\u1ee9ng c\u1ee7a ti\u1ec1n s\u1ea3n gi\u1eadt v\u00e0 th\u01b0\u1eddng h\u1ebft trong v\u00f2ng 42 ng\u00e0y sau khi sinh. T\u1ef7 l\u1ec7 g\u1eb7p t\u1eeb 6 – 7%.<\/p>\n

    \n
  • Ti\u1ec1n s\u1ea3n gi\u1eadt:<\/strong><\/li>\n<\/ul>\n

    Xu\u1ea5t hi\u1ec7n sau tu\u1ea7n th\u1ee9 20 c\u1ee7a thai k\u1ef3 k\u00e8m theo protein ni\u1ec7u 24 gi\u1edd > 300 mg ho\u1eb7c t\u1ef7 s\u1ed1 protein ni\u1ec7u\/creatinin ni\u1ec7u \u2265 30 mg\/mmol.<\/p>\n

    N\u1ebfu kh\u00f4ng c\u00f3 protein ni\u1ec7u, ti\u1ec1n s\u1ea3n gi\u1eadt \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi t\u0103ng huy\u1ebft \u00e1p m\u1edbi m\u1eafc k\u00e8m m\u1ed9t trong nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m sau: s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u gi\u1ea3m < 100.000\/^L, n\u1ed3ng \u0111\u1ed9 creatimn m\u00e1u > 1,1 mg\/dL, ho\u1eb7c g\u1ea5p \u0111\u00f4i n\u1ed3ng \u0111\u1ed9 creatinin \u1edf ng\u01b0\u1eddi kh\u00f4ng c\u00f3 b\u1ec7nh th\u1eadn kh\u00e1c, n\u1ed3ng \u0111\u1ed9 men gan t\u0103ng g\u1ea5p \u0111\u00f4i, ph\u00f9 ph\u1ed5i c\u1ea5p, c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u th\u1ea7n kinh ho\u1eb7c th\u1ecb gi\u00e1c. T\u1ef7 l\u1ec7 g\u1eb7p 2 – 5%\u00a0c\u00f3 t\u1eeb tr\u01b0\u1edbc l\u00e0m t\u0103ng n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng c\u1ee7a t\u0103ng huy\u1ebft \u00e1p thai k\u1ef3 c\u00f3 protein ni\u1ec7u.<\/p>\n

    T\u0103ng huy\u1ebft \u00e1p kh\u00f4ng ph\u00e2n lo\u1ea1i tr\u01b0\u1edbc sinh <\/strong>: Thu\u1eadt ng\u1eef n\u00e0y \u0111\u01b0\u1ee3c d\u00f9ng khi huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c \u0111o l\u1ea7n \u0111\u1ea7u ti\u00ean sau tu\u1ea7n th\u1ee9 20 c\u1ee7a thai k\u1ef3 v\u00e0 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 t\u0103ng huy\u1ebft \u00e1p. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 l\u1ea1i sau 42 ng\u00e0y sau sinh l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n.<\/p>\n

    2. Ph\u00f2ng ng\u1eeba ti\u1ec1n s\u1ea3n gi\u1eadt<\/strong><\/h2>\n

    Nh\u1eefng ph\u1ee5 n\u1eef c\u00f3 nguy c\u01a1 cao ho\u1eb7c nguy c\u01a1 v\u1eeba m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt n\u00ean u\u1ed1ng aspirin 100 – 150 mg m\u1ed7i ng\u00e0y t\u1eeb tu\u1ea7n 12 \u0111\u1ebfn tu\u1ea7n 36 – 37.<\/p>\n

    Nguy c\u01a1 m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt cao g\u1ed3m: T\u0103ng huy\u1ebft \u00e1p \u1edf l\u1ea7n mang thai tr\u01b0\u1edbc, b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh, b\u1ec7nh t\u1ef1 mi\u1ec5n nh\u01b0 lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng ho\u1eb7c h\u1ed9i ch\u1ee9ng kh\u00e1ng phospholipid, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 1 ho\u1eb7c type 2, t\u0103ng huy\u1ebft \u00e1p m\u1ea1n t\u00ednh.<\/p>\n

    Nguy c\u01a1 m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt v\u1eeba g\u1ed3m: Mang thai l\u1ea7n \u0111\u1ea7u, tu\u1ed5i \u2265 40, kho\u1ea3ng c\u00e1ch gi\u1eefa c\u00e1c l\u1ea7n mang thai > 10 n\u0103m, BMI \u2265 35 kg\/m 2 \u1edf l\u1ea7n kh\u00e1m \u0111\u1ea7u ti\u00ean, ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi b\u1ecb ti\u1ec1n s\u1ea3n gi\u1eadt, mang thai nhi\u1ec1u l\u1ea7n.<\/p>\n

    B\u1ed5 sung canxi (1,5 – 2 g\/24h) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 ph\u00f2ng ng\u1eeba ti\u1ec1n s\u1ea3n gi\u1eadt \u1edf ph\u1ee5 n\u1eef dinh d\u01b0\u1ee1ng k\u00e9m. Vitamin C v\u00e0 E kh\u00f4ng l\u00e0m gi\u1ea3m nguy c\u01a1 ti\u1ec1n s\u1ea3n gi\u1eadt.<\/p>\n

      \n
    • C\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb:<\/li>\n<\/ul>\n

      C\u00e1c thu\u1ed1c h\u1ea1 \u00e1p v\u00e0 t\u00ednh an to\u00e0n v\u1edbi ph\u1ee5 n\u1eef c\u00f3 thai (Theo ESC 2018)<\/p>\n\n\n\n\n\n\n\n\n\n\n
      T\u00ean thu\u1ed1c<\/strong><\/td>\nM\u1ee9c \u0111\u1ed9 khuy\u1ebfn c\u00e1o<\/strong><\/p>\n

      c\u1ee7a FDA<\/strong><\/td>\n

      		Thu\u1ed1c \u0111i qua rau thai ho\u1eb7c s\u1eefa<\/strong><\/td>\nT\u00e1c d\u1ee5ng ph\u1ee5<\/strong><\/td>\n<\/tr>\n
      Methyldopa<\/td>\nB<\/td>\nQua rau: c\u00f3 Qua s\u1eefa: c\u00f3<\/td>\nH\u1ea1 huy\u1ebft \u00e1p nh\u1eb9 \u1edf thai nhi<\/td>\n<\/tr>\n
      Atenolol<\/td>\nD<\/td>\nQua rau: c\u00f3 Qua s\u1eefa: C\u00f3<\/td>\nThai nhi: nh\u1eb9 c\u00e2n, nh\u1ecbp ch\u1eadm v\u00e0 h\u1ea1 \u0111\u01b0\u1eddng m\u00e1u<\/td>\n<\/tr>\n
      Bisoprolol<\/td>\nC<\/td>\nQua rau: c\u00f3<\/p>\n

       <\/p>\n

      Qua s\u1eefa: c\u00f3<\/td>\n

      		Thai nhi: nh\u1ecbp ch\u1eadm v\u00e0 h\u1ea1 \u0111\u01b0\u1eddng m\u00e1u<\/td>\n<\/tr>\n
      Metoprolol<\/td>\nC<\/td>\nQua rau: c\u00f3<\/p>\n

       <\/p>\n

      Qua s\u1eefa: c\u00f3<\/td>\n

      		Thai nhi: nh\u1ecbp ch\u1eadm v\u00e0 h\u1ea1 \u0111\u01b0\u1eddng m\u00e1u<\/td>\n<\/tr>\n
      Labetalol<\/td>\nC<\/td>\nQua rau: c\u00f3<\/p>\n

       <\/p>\n

      Qua s\u1eefa: c\u00f3<\/td>\n

      		Thai nhi: ch\u1eadm ph\u00e1t tri\u1ec3n trong t\u1eed cung, nh\u1ecbp ch\u1eadm, h\u1ea1 \u0111\u01b0\u1eddng m\u00e1u<\/td>\n<\/tr>\n
      Nifedipin<\/td>\nC<\/td>\nQua rau: c\u00f3<\/p>\n

       <\/p>\n

      Qua s\u1eefa: c\u00f3<\/td>\n

      		H\u1ea1 huy\u1ebft \u00e1p \u1edf m\u1eb9 v\u00e0 h\u1ea1 oxy m\u00e1u<\/p>\n

      \u1edf thai<\/td>\n<\/tr>\n

      Verapamil<\/td>\nC<\/td>\nQua rau: c\u00f3<\/p>\n

       <\/p>\n

      Qua s\u1eefa: c\u00f3<\/td>\n

      		Dung n\u1ea1p t\u1ed1t<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n
      C\u00e1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin II<\/td>\nD<\/td>\nQua rau: c\u00f3<\/p>\n

       <\/p>\n

      Qua s\u1eefa: c\u00f3<\/td>\n

      		Thai nhi: lo\u1ea1n s\u1ea3n th\u1eadn ho\u1eb7c \u1ed1ng th\u1eadn, r\u1ed1i lo\u1ea1n ph\u00e1t tri\u1ec3n x\u01b0\u01a1ng s\u1ecd, kh\u1edbp l\u1edbn, gi\u1ea3m s\u1ea3n ph\u1ed5i, thi\u1ebfu m\u00e1u, thai l\u01b0u<\/td>\n<\/tr>\n
      Spironolacton<\/td>\nD<\/td>\nQua rau: c\u00f3<\/p>\n

       <\/p>\n

      Qua s\u1eefa: c\u00f3<\/td>\n

      		T\u00e1c d\u1ee5ng kh\u00e1ng androgen<\/td>\n<\/tr>\n
      Furosemid<\/td>\nC<\/td>\nQua rau: c\u00f3<\/p>\n

       <\/p>\n

      Qua s\u1eefa: c\u00f3<\/td>\n

      		Thi\u1ec3u \u1ed1i<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      Ghi ch\u00fa v\u1ec1 ph\u00e2n lo\u1ea1i FDA v\u1ec1 t\u00ednh an to\u00e0n c\u1ee7a thu\u1ed1c: Lo\u1ea1i B (Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 nguy c\u01a1). Lo\u1ea1i C (c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean thai \u1edf nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt. Ch\u01b0a c\u00f3 nghi\u00ean c\u1ee9u thi\u1ebft k\u1ebf t\u1ed1t tr\u00ean ng\u01b0\u1eddi). Lo\u1ea1i D (c\u00f3 b\u1eb1ng ch\u1ee9ng g\u00e2y h\u1ea1i tr\u00ean ng\u01b0\u1eddi. C\u00e2n nh\u1eafc nguy c\u01a1 cho thai nhi v\u00e0 l\u1ee3i \u00edch cho m\u1eb9).<\/em><\/p>\n

      Ch\u00fa th\u00edch: ESC: H\u1ed9i Tim m\u1ea1ch Ch\u00e2u \u00c2u; FDA: The Food and Drug Administration (C\u1ee5c qu\u1ea3n l\u00fd Th\u1ef1c ph\u1ea9m v\u00e0 D\u01b0\u1ee3c ph\u1ea9m Hoa K\u1ef3).<\/em><\/p>\n

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

      T\u0103ng huy\u1ebft \u00e1p g\u1eb7p \u1edf 5 – 10% ph\u1ee5 n\u1eef mang thai tr\u00ean th\u1ebf gi\u1edbi, \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh l\u00fd tim m\u1ea1ch h\u00e0ng \u0111\u1ea7u l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong cho m\u1eb9, thai nhi v\u00e0 tr\u1ebb s\u01a1 sinh.<\/p>\n

      T\u0103ng huy\u1ebft \u00e1p trong thai k\u1ef3 l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 ph\u1ed5 bi\u1ebfn v\u00e0 nguy hi\u1ec3m \u0111\u1ed1i v\u1edbi s\u1ee9c kh\u1ecfe c\u1ee7a c\u1ea3 m\u1eb9 v\u00e0 thai nhi. Khi ph\u1ee5 n\u1eef mang thai, c\u01a1 th\u1ec3 c\u00f3 nhu c\u1ea7u l\u1edbn h\u01a1n v\u1ec1 m\u00e1u \u0111\u1ec3 cung c\u1ea5p dinh d\u01b0\u1ee1ng cho thai nhi v\u00e0 h\u1ed7 tr\u1ee3 s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u01a1 quan b\u00ean trong. Tuy nhi\u00ean, khi huy\u1ebft \u00e1p c\u1ee7a ph\u1ee5 n\u1eef t\u0103ng qu\u00e1 cao, n\u00f3 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe nghi\u00eam tr\u1ecdng nh\u01b0 \u0111\u1ed9t qu\u1ef5, b\u1ec7nh tim v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n","protected":false},"excerpt":{"rendered":"

      T\u0103ng huy\u1ebft \u00e1p g\u1eb7p \u1edf 5 – 10% ph\u1ee5 n\u1eef mang thai tr\u00ean th\u1ebf gi\u1edbi, \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh l\u00fd tim m\u1ea1ch h\u00e0ng \u0111\u1ea7u l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong cho m\u1eb9, thai nhi v\u00e0 tr\u1ebb s\u01a1 sinh. Nguy c\u01a1 c\u1ee7a m\u1eb9 bao g\u1ed3m rau bong non, \u0111\u1ed9t qu\u1ef5, suy \u0111a t\u1ea1ng, t\u1eed […]<\/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":"\nT\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef c\u00f3 thai - Vinmec<\/title>\n<meta name=\"description\" content=\"T\u0103ng huy\u1ebft \u00e1p ph\u1ee5 n\u1eef mang thai tr\u00ean th\u1ebf gi\u1edbi, \u0111\u00e2y l\u00e0 b\u1ec7nh l\u00fd tim m\u1ea1ch h\u00e0ng \u0111\u1ea7u l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong cho m\u1eb9, thai nhi v\u00e0 tr\u1ebb s\u01a1 sinh.\" \/>\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=\"T\u0103ng huy\u1ebft \u00e1p \u1edf ph\u1ee5 n\u1eef c\u00f3 thai - 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