{"id":7684,"date":"2024-12-11T13:31:27","date_gmt":"2024-12-11T06:31:27","guid":{"rendered":"https:\/\/bvndgiadinh.org.vn\/?p=7684"},"modified":"2024-12-11T13:31:27","modified_gmt":"2024-12-11T06:31:27","slug":"cuu-song-san-phu-do-nhiem-cum-a-bang-phuong-phap-vv-ecmo","status":"publish","type":"post","link":"https:\/\/bvndgiadinh.org.vn\/?p=7684","title":{"rendered":"C\u1ee8U S\u1ed0NG S\u1ea2N PH\u1ee4 DO NHI\u1ec4M C\u00daM A B\u1eb0NG PH\u01af\u01a0NG PH\u00c1P VV-ECMO"},"content":{"rendered":"\n

C\u00e1c b\u00e1c s\u0129 t\u1ea1i B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh v\u1eeba c\u1ee9u s\u1ed1ng s\u1ea3n ph\u1ee5 M.T.H.N, 21 tu\u1ed5i, ng\u1ee5 TP.HCM, nh\u1eadp vi\u1ec7n trong t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p nguy k\u1ecbch do nhi\u1ec5m c\u00fam A. Nh\u1edd s\u1ef1 ph\u1ed1i h\u1ee3p nh\u1ecbp nh\u00e0ng gi\u1eefa c\u00e1c chuy\u00ean khoa v\u00e0 \u00e1p d\u1ee5ng k\u1ef9 thu\u1eadt oxy h\u00f3a m\u00e1u m\u00e0ng ngo\u00e0i c\u01a1 th\u1ec3 (VV-ECMO), t\u00ednh m\u1ea1ng c\u1ee7a c\u1ea3 m\u1eb9 v\u00e0 b\u00e9 \u0111\u00e3 \u0111\u01b0\u1ee3c b\u1ea3o to\u00e0n.<\/em><\/strong><\/p>\n\n\n\n

S\u1ea3n ph\u1ee5 M.T.H.N mang thai l\u1ea7n \u0111\u1ea7u ho\u00e0n to\u00e0n kh\u1ecfe m\u1ea1nh v\u00e0 kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh l\u00fd tim m\u1ea1ch hay h\u00f4 h\u1ea5p. Khi thai \u0111\u01b0\u1ee3c g\u1ea7n 33 tu\u1ea7n tu\u1ed5i, ch\u1ecb N. v\u00e0 c\u00e1c th\u00e0nh vi\u00ean trong gia \u0111\u00ecnh c\u00f3 tri\u1ec7u ch\u1ee9ng s\u1ed1t nh\u1eb9, ho, ch\u1ea3y m\u0169i, \u0111au h\u1ecdng. T\u01b0\u1edfng ch\u1eebng ch\u1ec9 l\u00e0 c\u1ea3m l\u1ea1nh th\u00f4ng th\u01b0\u1eddng, ch\u1ecb N. v\u1eabn kh\u00f4ng quan t\u00e2m v\u00e0 ti\u1ebfp t\u1ee5c l\u00e0m vi\u1ec7c b\u00ecnh th\u01b0\u1eddng. Tuy nhi\u00ean, sau 4 ng\u00e0y, ch\u1ecb N. b\u1eaft \u0111\u1ea7u c\u1ea3m th\u1ea5y kh\u00f3 th\u1edf, s\u1ed1t cao n\u00ean \u0111\u00e3 \u0111\u1ebfn B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh kh\u00e1m v\u00e0 nh\u1eadp vi\u1ec7n.<\/p>\n\n\n\n

Ch\u1ec9 trong v\u00f2ng ch\u01b0a \u0111\u1ebfn 12 gi\u1edd sau nh\u1eadp vi\u1ec7n, suy h\u00f4 h\u1ea5p ti\u1ebfn tri\u1ec3n r\u1ea5t nhanh, t\u1ed5n th\u01b0\u01a1ng \u0111\u00f4ng \u0111\u1eb7c g\u1ea7n 80% nhu m\u00f4 ph\u1ed5i khi\u1ebfn ch\u1ecb N. ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 th\u00f4ng kh\u00ed x\u00e2m l\u1ea5n. M\u1eb7c d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 th\u1edf m\u00e1y t\u1ed1i \u0111a, nh\u01b0ng do oxy m\u00e1u c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh qu\u00e1 th\u1ea5p \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o t\u00ednh m\u1ea1ng cho c\u1ea3 m\u1eb9 v\u00e0 b\u00e9. Ngay l\u1eadp t\u1ee9c, c\u00e1c b\u00e1c s\u0129 s\u1ea3n khoa v\u00e0 h\u1ed3i s\u1ee9c tim m\u1ea1ch t\u1ea1i B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh v\u1eeba m\u1ed5 l\u1ea5y thai c\u1ea5p c\u1ee9u, v\u1eeba can thi\u1ec7p oxy h\u00f3a m\u00e1u m\u00e0ng ngo\u00e0i c\u01a1 th\u1ec3 (VV-ECMO). Sau 21 ng\u00e0y can thi\u1ec7p ECMO, ch\u1ecb N. hi\u1ec7n \u0111\u00e3 ph\u1ee5c h\u1ed3i g\u1ea7n nh\u01b0 ho\u00e0n to\u00e0n v\u00e0 s\u1eafp \u0111\u01b0\u1ee3c tr\u1edf v\u1ec1 b\u00ean gia \u0111\u00ecnh v\u00e0 thi\u00ean th\u1ea7n nh\u1ecf.<\/p>\n\n\n\n

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      Th\u1ea1c s\u0129 – B\u00e1c s\u0129 Tr\u1ea7n Thanh Nam \u2013 Khoa H\u1ed3i s\u1ee9c tim m\u1ea1ch, B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh cho bi\u1ebft: \u201cS\u1ea3n ph\u1ee5 nh\u1eadp vi\u1ec7n trong b\u1ec7nh c\u1ea3nh r\u1ea5t n\u1eb7ng, h\u1ed9i ch\u1ee9ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ea5p v\u1edbi t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 ph\u1ed5i hai b\u00ean g\u1ea7n nh\u01b0 ho\u00e0n to\u00e0n v\u00e0 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m d\u1ecbch ti\u1ebft ph\u1ebf qu\u1ea3n d\u01b0\u01a1ng t\u00ednh v\u1edbi c\u00fam A. Sau khi c\u00e1c b\u00e1c s\u0129 s\u1ea3n khoa x\u00e1c \u0111\u1ecbnh thai k\u1ef3 ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng theo tu\u1ed5i thai, v\u1edbi t\u00ecnh tr\u1ea1ng nguy k\u1ecbch h\u00f4 h\u1ea5p c\u1ee7a m\u1eb9, ch\u00fang t\u00f4i \u0111\u00e3 quy\u1ebft \u0111\u1ecbnh m\u1ed5 l\u1ea5y thai c\u1ea5p c\u1ee9u \u0111\u1ec3 c\u00f3 th\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n t\u1ed1t nh\u1ea5t cho b\u00e9, \u0111\u1ed3ng th\u1eddi, can thi\u1ec7p oxy h\u00f3a m\u00e1u m\u00e0ng ngo\u00e0i c\u01a1 th\u1ec3 ph\u01b0\u01a1ng th\u1ee9c t\u0129nh – t\u0129nh m\u1ea1ch (VV-ECMO) nh\u1eb1m h\u1ed7 tr\u1ee3 ph\u1ed5i v\u00e0 c\u1ee9u t\u00ednh m\u1ea1ng m\u1eb9. Ngay sau khi m\u1ed5 l\u1ea5y thai, \u00ea-k\u00edp b\u00e1c s\u0129 h\u1ed3i s\u1ee9c s\u01a1 sinh \u0111\u00e3 s\u1eb5n s\u00e0ng c\u00f3 m\u1eb7t \u0111\u1ec3 h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p cho b\u00e9 sinh non th\u00e1ng. S\u1ef1 ph\u1ed1i h\u1ee3p nh\u1ecbp nh\u00e0ng gi\u1eefa c\u00e1c chuy\u00ean khoa \u0111\u00e3 x\u1eed tr\u00ed c\u1ea5p c\u1ee9u ban \u0111\u1ea7u hi\u1ec7u qu\u1ea3 cho c\u1ea3 m\u1eb9 v\u00e0 b\u00e9\u201d.<\/p>\n\n\n\n

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Th\u1ea1c s\u0129 – B\u00e1c s\u0129 L\u00ea V\u0169 Nh\u01b0 Qu\u1ef3nh \u2013 Khoa H\u1ed3i s\u1ee9c tim m\u1ea1ch, b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb ch\u00ednh c\u1ee7a s\u1ea3n ph\u1ee5 N. k\u1ec3 l\u1ea1i: \u201cM\u1eb7c d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c can thi\u1ec7p VV-ECMO nh\u01b0ng v\u1edbi t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 ph\u1ed5i qu\u00e1 n\u1eb7ng do c\u00fam, c\u00f3 nh\u1eefng th\u1eddi \u0111i\u1ec3m, oxy m\u00e1u s\u1ea3n ph\u1ee5 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1ea3m b\u1ea3o trong m\u1ee9c an to\u00e0n. Sau 5 ng\u00e0y ki\u1ec3m so\u00e1t th\u00e2n nhi\u1ec7t, an th\u1ea7n s\u00e2u, gi\u00e3n c\u01a1, th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i, oxy h\u00f3a m\u00e1u m\u1edbi b\u1eaft \u0111\u1ea7u c\u1ea3i thi\u1ec7n d\u1ea7n. Sau 1 tu\u1ea7n can thi\u1ec7p VV-ECMO, ch\u1ecb N. t\u1ec9nh t\u00e1o ho\u00e0n to\u00e0n v\u00e0 b\u1eaft \u0111\u1ea7u t\u1eadp v\u1eadt l\u00fd tr\u1ecb li\u1ec7u h\u00f4 h\u1ea5p c\u00f3 tr\u1ee3 gi\u00fap v\u1edbi c\u01b0\u1eddng \u0111\u1ed9 t\u0103ng d\u1ea7n. Th\u00f4ng th\u01b0\u1eddng, c\u00e1c t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do c\u00fam s\u1ebd c\u1ea3i thi\u1ec7n sau 5 – 7 ng\u00e0y, nh\u01b0ng do t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh qu\u00e1 n\u1eb7ng, ch\u1ee9c n\u0103ng ph\u1ed5i ph\u1ea3i c\u1ea7n \u0111\u1ebfn h\u01a1n 2 tu\u1ea7n m\u1edbi c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t\u201d.<\/p>\n\n\n\n

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Theo Ti\u1ebfn s\u0129 – B\u00e1c s\u0129 V\u00f5 H\u1ed3ng Minh C\u00f4ng, Ph\u00f3 Gi\u00e1m \u0111\u1ed1c B\u1ec7nh vi\u1ec7n Nh\u00e2n D\u00e2n Gia \u0110\u1ecbnh, \u0111\u00e2y l\u00e0 m\u1ed9t tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec3n h\u00ecnh cho th\u1ea5y s\u1ef1 nguy hi\u1ec3m c\u1ee7a c\u00fam m\u00f9a, \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u1edbi ph\u1ee5 n\u1eef mang thai. M\u1eb7c d\u00f9, c\u00fam m\u00f9a th\u01b0\u1eddng kh\u00f4ng g\u00e2y tri\u1ec7u ch\u1ee9ng nguy k\u1ecbch tr\u00ean ng\u01b0\u1eddi c\u00f3 h\u1ec7 mi\u1ec5n d\u1ecbch kh\u1ecfe m\u1ea1nh, tuy nhi\u00ean tr\u00ean c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 nguy c\u01a1 cao, \u0111\u1eb7c bi\u1ec7t l\u00e0 thai ph\u1ee5, c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u bi\u1ebfn ch\u1ee9ng n\u1eb7ng th\u1eadm ch\u00ed \u0111e d\u1ecda t\u00ednh m\u1ea1ng. Ph\u1ee5 n\u1eef mang thai m\u1eafc c\u00fam c\u00f3 th\u1ec3 c\u00f2n g\u1eb7p c\u00e1c bi\u1ebfn ch\u1ee9ng trong thai k\u1ef3 nh\u01b0 sinh non, thai ch\u1ebft l\u01b0u, ho\u1eb7c tr\u1ebb sinh ra b\u1ecb nh\u1eb9 c\u00e2n.<\/p>\n\n\n\n

 Ti\u1ebfn s\u0129 – B\u00e1c s\u0129 V\u00f5 H\u1ed3ng Minh C\u00f4ng \u0111\u1eb7c bi\u1ec7t nh\u1ea5n m\u1ea1nh: Trong thai k\u1ef3, h\u1ec7 mi\u1ec5n d\u1ecbch c\u1ee7a ng\u01b0\u1eddi ph\u1ee5 n\u1eef c\u00f3 nh\u1eefng thay \u0111\u1ed5i nh\u1ea5t \u0111\u1ecbnh khi\u1ebfn h\u1ecd d\u1ec5 b\u1ecb nhi\u1ec5m tr\u00f9ng h\u01a1n. B\u00ean c\u1ea1nh \u0111\u00f3, s\u1ef1 thay \u0111\u1ed5i v\u1ec1 gi\u1ea3i ph\u1eabu l\u1ed3ng ng\u1ef1c v\u00e0 h\u1ec7 th\u1ed1ng tim m\u1ea1ch trong thai k\u1ef3 c\u0169ng l\u00e0m t\u0103ng nguy c\u01a1 bi\u1ebfn ch\u1ee9ng h\u00f4 h\u1ea5p khi m\u1eafc c\u00fam. V\u00ec v\u1eady, vi\u1ec7c ph\u00f2ng ng\u1eeba c\u00fam m\u00f9a \u1edf ph\u1ee5 n\u1eef mang thai l\u00e0 v\u00f4 c\u00f9ng quan tr\u1ecdng. Ti\u00eam ph\u00f2ng c\u00fam l\u00e0 bi\u1ec7n ph\u00e1p ch\u1ee7 \u0111\u1ed9ng gi\u00fap ph\u00f2ng ng\u1eeba c\u00fam an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 nh\u1ea5t cho ph\u1ee5 n\u1eef mang thai.<\/p>\n\n\n\n

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Theo th\u1ed1ng k\u00ea, ti\u00eam ph\u00f2ng c\u00fam gi\u00fap gi\u1ea3m t\u1edbi 50% nguy c\u01a1 m\u1eafc c\u00fam \u1edf ph\u1ee5 n\u1eef mang thai v\u00e0 40% nguy c\u01a1 nh\u1eadp vi\u1ec7n do c\u00fam. Kh\u00f4ng ch\u1ec9 b\u1ea3o v\u1ec7 m\u1eb9 v\u1edbi c\u00fam m\u00f9a, v\u1eafc xin c\u00fam c\u00f2n gi\u00fap t\u1ea1o kh\u00e1ng th\u1ec3 truy\u1ec1n sang cho b\u00e9 gi\u00fap b\u1ea3o v\u1ec7 b\u00e9 trong nh\u1eefng th\u00e1ng \u0111\u1ea7u \u0111\u1eddi. \u0110\u1ec3 ph\u00f2ng ng\u1eeba c\u00fam hi\u1ec7u qu\u1ea3, ngo\u00e0i vi\u1ec7c ti\u00eam ph\u00f2ng c\u00fam, ph\u1ee5 n\u1eef mang thai n\u00ean tu\u00e2n th\u1ee7 c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba chung nh\u01b0: R\u1eeda tay th\u01b0\u1eddng xuy\u00ean, \u0111\u00fang c\u00e1ch; che mi\u1ec7ng khi ho, h\u1eaft h\u01a1i; tr\u00e1nh ti\u1ebfp x\u00fac v\u1edbi ng\u01b0\u1eddi b\u1ec7nh; v\u1ec7 sinh nh\u00e0 c\u1eeda v\u00e0 n\u01a1i l\u00e0m vi\u1ec7c s\u1ea1ch s\u1ebd, tho\u00e1ng m\u00e1t; duy tr\u00ec l\u1ed1i s\u1ed1ng l\u00e0nh m\u1ea1nh nh\u01b0 \u0103n u\u1ed1ng \u0111\u1ee7 ch\u1ea5t, ngh\u1ec9 ng\u01a1i h\u1ee3p l\u00fd. N\u1ebfu c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng nghi ng\u1edd c\u00fam, ph\u1ee5 n\u1eef mang thai c\u1ea7n \u0111\u1ebfn ngay c\u01a1 s\u1edf y t\u1ebf \u0111\u1ec3 \u0111\u01b0\u1ee3c kh\u00e1m, ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi v\u00e0 kh\u00f4ng t\u1ef1 \u00fd mua thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u1ea1i nh\u00e0.<\/p>\n\n\n\n

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C\u00e1c b\u00e1c s\u0129 t\u1ea1i B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh v\u1eeba c\u1ee9u s\u1ed1ng s\u1ea3n ph\u1ee5 M.T.H.N, 21 tu\u1ed5i, ng\u1ee5 TP.HCM, nh\u1eadp vi\u1ec7n trong t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p nguy k\u1ecbch do nhi\u1ec5m c\u00fam A. Nh\u1edd s\u1ef1 ph\u1ed1i h\u1ee3p nh\u1ecbp nh\u00e0ng gi\u1eefa c\u00e1c chuy\u00ean khoa v\u00e0 \u00e1p d\u1ee5ng k\u1ef9 thu\u1eadt oxy h\u00f3a m\u00e1u m\u00e0ng ngo\u00e0i c\u01a1 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