{"id":4725,"date":"2023-12-28T16:23:11","date_gmt":"2023-12-28T09:23:11","guid":{"rendered":"https:\/\/bvndgiadinh.org.vn\/?p=4725"},"modified":"2024-01-08T15:40:14","modified_gmt":"2024-01-08T08:40:14","slug":"cuu-song-san-phu-hoi-chung-hellp-do-tien-san-giat-nang-kem-hoi-chung-nguy-kich-ho-hap-capcuu-song-san-phu-hoi-chung-hellp-do-tien-san-giat-nang","status":"publish","type":"post","link":"https:\/\/bvndgiadinh.org.vn\/?p=4725","title":{"rendered":"C\u1ee8U S\u1ed0NG S\u1ea2N PH\u1ee4 H\u1ed8I CH\u1ee8NG HELLP DO TI\u1ec0N S\u1ea2N GI\u1eacT N\u1eb6NG K\u00c8M H\u1ed8I CH\u1ee8NG NGUY K\u1ecaCH H\u00d4 H\u1ea4P C\u1ea4P C\u1ee8U S\u1ed0NG S\u1ea2N PH\u1ee4 H\u1ed8I CH\u1ee8NG HELLP DO TI\u1ec0N S\u1ea2N GI\u1eacT N\u1eb6NG"},"content":{"rendered":"\n

B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh \u0111\u00e3 c\u1ea5p c\u1ee9u v\u00e0 \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng tr\u01b0\u1eddng h\u1ee3p s\u1ea3n ph\u1ee5 mang thai \u1edf tu\u1ea7n 29 thai k\u1ef3 b\u1ecb H\u1ed9i ch\u1ee9ng HELLP – m\u1ed9t bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ee7a b\u1ec7nh l\u00fd ti\u1ec1n s\u1ea3n gi\u1eadt n\u1eb7ng v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u suy th\u1eadn c\u1ea5p k\u00e8m tr\u00e0n d\u1ecbch \u0111a m\u00e0ng. S\u1ea3n ph\u1ee5 \u0111\u01b0\u1ee3c m\u1ed5 l\u1ea5y thai c\u1ea5p c\u1ee9u c\u00f9ng ng\u00e0y. Sau m\u1ed5, t\u00ecnh tr\u1ea1ng suy th\u1eadn c\u1ea5p c\u1ee7a s\u1ea3n ph\u1ee5 ti\u1ebfn tri\u1ec3n n\u1eb7ng k\u00e8m t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i lan to\u1ea3 hai b\u00ean v\u00e0 suy h\u00f4 h\u1ea5p \u0111e do\u1ea1 t\u00ednh m\u1ea1ng c\u1ee7a m\u1eb9. Sau 28 ng\u00e0y \u0111\u00eam \u0111\u01b0\u1ee3c c\u00e1c b\u00e1c s\u1ef9 t\u00edch c\u1ef1c \u0111i\u1ec1u tr\u1ecb, s\u1ea3n ph\u1ee5 \u0111\u00e3 xu\u1ea5t vi\u1ec7n v\u1edbi t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe \u1ed5n \u0111\u1ecbnh<\/em><\/strong>.<\/p>\n\n\n\n

S\u1ea3n ph\u1ee5 Di\u1ec7p Th\u1ecb Ng\u1ecdc P., 38 tu\u1ed5i, nh\u1eadp vi\u1ec7n ng\u00e0y 29.11.2023 t\u1ea1i b\u1ec7nh vi\u1ec7n T\u1eeb D\u0169 v\u1edbi ch\u1ea9n \u0111o\u00e1n con l\u1ea7n 4, thai 29 tu\u1ea7n, ti\u1ec1n s\u1ea3n gi\u1eadt n\u1eb7ng k\u00e8m h\u1ed9i ch\u1ee9ng HELLP (t\u00e1n huy\u1ebft, t\u0103ng men gan, gi\u1ea3m ti\u1ec3u c\u1ea7u), suy th\u1eadn c\u1ea5p k\u00e8m tr\u00e0n d\u1ecbch \u0111a m\u00e0ng. S\u1ea3n ph\u1ee5 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh m\u1ed5 l\u1ea5y thai c\u1ea5p c\u1ee9u c\u00f9ng ng\u00e0y. B\u00e9 trai sinh non ch\u1ec9 650gram, \u0111\u01b0\u1ee3c chuy\u1ec3n khoa S\u01a1 Sinh ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t. Sau m\u1ed5, t\u00ecnh tr\u1ea1ng suy th\u1eadn c\u1ea5p c\u1ee7a s\u1ea3n ph\u1ee5 ti\u1ebfn tri\u1ec3n n\u1eb7ng k\u00e8m t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i lan to\u1ea3 hai b\u00ean v\u00e0 suy h\u00f4 h\u1ea5p. Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c h\u1ed9i ch\u1ea9n li\u00ean b\u1ec7nh vi\u1ec7n v\u1edbi c\u00e1c chuy\u00ean gia tim m\u1ea1ch – s\u1ea3n khoa ng\u00e0y 01.12.2023 v\u00e0 chuy\u1ec3n vi\u1ec7n nhanh ch\u00f3ng sang B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh nh\u1eb1m can thi\u1ec7p h\u1ed3i s\u1ee9c tim m\u1ea1ch chuy\u00ean s\u00e2u.   <\/p>\n\n\n\n

Nh\u1eadn \u0111\u1ecbnh v\u1ec1 ca b\u1ec7nh, ThS.BS Giang Minh Nh\u1eadt – Tr\u01b0\u1edfng \u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c t\u00edch c\u1ef1c tim  m\u1ea1ch \u2013 B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh cho bi\u1ebft : \u201cKhi \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ebfn<\/em> b\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh, t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n di\u1ec5n ti\u1ebfn nguy <\/em>hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng<\/em> (h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p) kh\u00f4ng \u0111\u00e1p \u1ee9ng th\u1edf m\u00e1y x\u00e2m l\u1ea5n, t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i tr\u00ean Xquang ng\u1ef1c chi\u1ebfm h\u01a1n 80% th\u1ec3 t\u00edch ph\u1ed5i. S\u1ea3n ph\u1ee5 P. \u0111\u01b0\u1ee3c can thi\u1ec7p VV-ECMO (oxy ho\u00e1 m\u00e1u m\u00e0ng ngo\u00e0i c\u01a1 th\u1ec3) c\u1ea5p c\u1ee9u v\u00ec suy h\u00f4 h\u1ea5p gi\u1ea3m oxy m\u00e1u kh\u00e1ng tr\u1ecb. Sau can thi\u1ec7p VV-ECMO v\u00e0 l\u1ecdc m\u00e1u li\u00ean t\u1ee5c 14 ng\u00e0y, t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p v\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p c\u1ee7a s\u1ea3n ph\u1ee5 P. h\u1ed3i ph\u1ee5c ngo\u1ea1n m\u1ee5c, t\u1ed5n th\u01b0\u01a1ng gan, gi\u1ea3m ti\u1ec3u c\u1ea7u v\u00e0 t\u00e1n huy\u1ebft \u0111\u1ec1u \u1ed5n \u0111\u1ecbnh. H\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p (ARDS) chi\u1ebfm kho\u1ea3ng 8% b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng HELLP n\u1eb7ng, v\u1edbi nguy c\u01a1 t\u1eed vong x\u1ea5p x\u1ec9 50%. Can thi\u1ec7p ECMO \u1edf s\u1ea3n ph\u1ee5 c\u00f3 h\u1ed9i ch\u1ee9ng HELLP th\u01b0\u1eddng c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u trong qu\u00e1 tr\u00ecnh th\u1ee7 thu\u1eadt v\u00e0 theo d\u00f5i r\u1ea5t cao do s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u trong m\u00e1u gi\u1ea3m n\u1eb7ng, \u0111\u00f2i h\u1ecfi c\u1ea7n c\u00f3 chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb kh\u00e1ng \u0111\u00f4ng h\u1ee3p l\u00fd.<\/em>\u201d<\/em> <\/em><\/p>\n\n\n\n

TS.BS B\u00f9i Ch\u00ed Th\u01b0\u01a1ng \u2013 Tr\u01b0\u1edfng kh\u1ed1i s\u1ea3n \u2013 B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh cho bi\u1ebft: \u201cH\u1ed9i ch\u1ee9ng HELLP l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng hi\u1ebfm chi\u1ebfm 0,1% \u0111\u1ebfn 1% c\u00e1c tr\u01b0\u1eddng h\u1ee3p mang thai, nh\u01b0ng r\u1ea5t nguy hi\u1ec3m trong thai k\u1ef3, bao g\u1ed3m t\u00e1n huy\u1ebft, t\u0103ng men gan, v\u00e0 gi\u1ea3m ti\u1ec3u c\u1ea7u. H\u1ed9i ch\u1ee9ng HELLP th\u01b0\u1eddng \u0111i k\u00e8m \u1edf s\u1ea3n ph\u1ee5 c\u00f3 t\u0103ng huy\u1ebft \u00e1p trong qu\u00e1 tr\u00ecnh mang thai. T\u1ec9 l\u1ec7 t\u1eed vong h\u1ed9i ch\u1ee9ng HELLP gi\u1ea3m r\u1ea5t th\u1ea5p trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y v\u1edbi nhi\u1ec1u ti\u1ebfn b\u1ed9<\/em> c\u1ee7a c\u00e1c k\u1ef9 thu\u1eadt hi\u1ec7n \u0111\u1ea1i c\u00f9ng s\u1ef1 ph\u1ed1i h\u1ee3p gi\u1eefa<\/em> chuy\u00ean ng\u00e0nh s\u1ea3n khoa v\u00e0 h\u1ed3i s\u1ee9c.<\/em> <\/em>H\u1ed9i ch\u1ee9ng n\u00e0y th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n trong ba th\u00e1ng cu\u1ed1i c\u1ee7a thai k\u1ef3, nh\u01b0ng c\u00f3 th\u1ec3 x\u1ea3y ra s\u1edbm h\u01a1n, ho\u1eb7c sau khi sinh.<\/em> <\/em>\u0110\u1ed1i t\u01b0\u1ee3ng c\u00f3 nguy c\u01a1 cao m\u1eafc b\u1ec7nh bao g\u1ed3m: Ph\u1ee5 n\u1eef tr\u00ean 35 tu\u1ed5i;<\/em> <\/em>B\u1ecb b\u00e9o ph\u00ec;<\/em> <\/em>C\u00f3 ti\u1ec1n s\u1eed m\u1eafc c\u00e1c b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng ho\u1eb7c b\u1ec7nh th\u1eadn;B\u1ecb huy\u1ebft \u00e1p cao trong thai k\u1ef3;<\/em> <\/em>Ti\u1ec1n s\u1eed m\u1eafc ti\u1ec1n s\u1ea3n gi\u1eadt tr\u01b0\u1edbc khi sinh\u2026<\/em>\u201d<\/em><\/p>\n\n\n\n

H\u1ed9i ch\u1ee9ng HELLP bi\u1ec3u hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p: ph\u00f9 ch\u00e2n, t\u0103ng huy\u1ebft \u00e1p, thai > 20 tu\u1ea7n ngo\u00e0i ra c\u00f2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111i k\u00e8m nh\u01b0 \u0111au th\u01b0\u1ee3ng v\u1ecb, \u0111au \u0111\u1ea7u, m\u1edd m\u1eaft, d\u1ec5 b\u1ecb k\u00edch th\u00edch, t\u0103ng ph\u1ea3n x\u1ea1, bu\u1ed3n n\u00f4n, n\u00f4n, v\u00e0ng da, xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da. H\u1ed9i ch\u1ee9ng HELLP x\u1ea3y ra \u1edf kho\u1ea3ng 4 – 12% b\u1ec7nh nh\u00e2n ti\u1ec1n s\u1ea3n gi\u1eadt, kho\u1ea3ng 30% tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t hi\u1ec7n trong nh\u1eefng tu\u1ea7n \u0111\u1ea7u sau sinh. Do \u0111\u00f3, d\u1ec5 nh\u1ea7m l\u1eabn v\u1edbi c\u00e1c b\u1ec7nh l\u00fd n\u1ed9i khoa nh\u01b0 b\u1ec7nh l\u00fd ti\u00eau h\u00f3a gan m\u1eadt, b\u1ec7nh l\u00fd th\u1eadn, b\u1ec7nh l\u00fd tim m\u1ea1ch\u2026 Ph\u00e2n bi\u1ec7t c\u00e1c b\u1ec7nh l\u00fd n\u00e0y c\u1ea7n ph\u1ed1i h\u1ee3p l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng. V\u00ec th\u1ebf, s\u1ea3n ph\u1ee5 khi g\u1eb7p c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y, c\u1ea7n \u0111\u1ebfn b\u00e1c s\u0129 chuy\u00ean khoa s\u1ea3n \u0111\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 can thi\u1ec7p k\u1ecbp th\u1eddi.<\/p>\n\n\n\n

<\/p>\n\n\n\n

\"H\u00ecnh<\/figure>\n\n\n\n

<\/p>\n\n\n\n

\"H\u00ecnh<\/figure>\n","protected":false},"excerpt":{"rendered":"

B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh \u0111\u00e3 c\u1ea5p c\u1ee9u v\u00e0 \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng tr\u01b0\u1eddng h\u1ee3p s\u1ea3n ph\u1ee5 mang thai \u1edf tu\u1ea7n 29 thai k\u1ef3 b\u1ecb H\u1ed9i ch\u1ee9ng HELLP – m\u1ed9t bi\u1ebfn ch\u1ee9ng n\u1eb7ng c\u1ee7a b\u1ec7nh l\u00fd ti\u1ec1n s\u1ea3n gi\u1eadt n\u1eb7ng v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u suy th\u1eadn c\u1ea5p k\u00e8m tr\u00e0n d\u1ecbch \u0111a m\u00e0ng. S\u1ea3n ph\u1ee5 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