{"id":33592,"date":"2022-08-12T19:47:37","date_gmt":"2022-08-12T12:47:37","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=33592"},"modified":"2022-08-13T09:07:51","modified_gmt":"2022-08-13T02:07:51","slug":"cam-bay-trong-theo-doi-huyet-dong-dua-tren-dang-song-ap-luc-dong-mach","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/cam-bay-trong-theo-doi-huyet-dong-dua-tren-dang-song-ap-luc-dong-mach\/","title":{"rendered":"C\u1ea1m b\u1eaby trong theo d\u00f5i huy\u1ebft \u0111\u1ed9ng d\u1ef1a tr\u00ean d\u1ea1ng s\u00f3ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch"},"content":{"rendered":"

T\u00e1c gi\u1ea3: Luigi Camporota and Richard Beale*<\/em><\/p>\n

vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft C\u1ea1m b\u1eaby trong theo d\u00f5i huy\u1ebft \u0111\u1ed9ng d\u1ef1a tr\u00ean d\u1ea1ng s\u00f3ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch<\/a>, xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y<\/a>.<\/p>\n

*Correspondence: richard.beale@gstt.nhs.uk<\/p>\n

Department of Adult Critical Care – Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, St Thomas\u2019 Hospital, 1st Floor East Wing – Lambeth Palace Road, London, SE1 7EH, UK<\/p>\n

C\u1ea1m b\u1eaby trong theo d\u00f5i huy\u1ebft \u0111\u1ed9ng d\u1ef1a tr\u00ean d\u1ea1ng s\u00f3ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch<\/h2>\n
\u0110\u1ed9 ch\u00ednh x\u00e1c c\u1ee7a h\u1ec7 th\u1ed1ng FloTrac-Vigileo cung l\u01b0\u1ee3ng tim d\u1ef1a tr\u00ean \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch v\u1eabn th\u1ea5p \u0111\u1ebfn m\u1ee9c kh\u00f4ng th\u1ec3 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c khi huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh. D\u1eef li\u1ec7u cho th\u1ea5y vi\u1ec7c \u0111o cung l\u01b0\u1ee3ng tim (CO) b\u1ecb \u1ea3nh h\u01b0\u1edfng m\u1ea1nh m\u1ebd b\u1edfi nh\u1eefng thay \u0111\u1ed5i c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch (ABP) – v\u00ed d\u1ee5, tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch v\u00e0 s\u1ef1 tu\u00e2n th\u1ee7 – compliance v\u00e0 v\u1ecb tr\u00ed \u0111\u1ed9ng m\u1ea1ch – \u0111\u1ed9c l\u1eadp v\u1edbi nh\u1eefng thay \u0111\u1ed5i th\u1ef1c s\u1ef1 trong CO. M\u1eb7c d\u00f9 tr\u00ean l\u00fd thuy\u1ebft, thu\u1eadt to\u00e1n t\u1ef1 hi\u1ec7u chu\u1ea9n c\u1ee7a FloTrac-Vigileo n\u00ean \u0111i\u1ec1u ch\u1ec9nh cho nh\u1eefng thay \u0111\u1ed5i \u0111\u00f3, m\u00f4 h\u00ecnh b\u00f9 tr\u1eeb d\u01b0\u1edbi m\u1ee9c (ho\u1eb7c b\u00f9 tr\u1eeb qu\u00e1 m\u1ee9c) cho nh\u1eefng t\u0103ng (ho\u1eb7c gi\u1ea3m) n\u1ed5i b\u1eadt trong tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch m\u00e1u v\u00e0 s\u1ef1 tu\u00e2n th\u1ee7, l\u00e0m cho h\u1ec7 th\u1ed1ng ph\u1ee5 thu\u1ed9c ph\u1ea7n l\u1edbn v\u00e0o nh\u1eefng thay \u0111\u1ed5i trong ABP. Nh\u1eefng h\u1ea1n ch\u1ebf n\u00e0y l\u00e0m cho FloTrac-Vigileo ch\u1ec9 ch\u00ednh x\u00e1c trong c\u00e1c \u0111i\u1ec1u ki\u1ec7n huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh v\u00e0 cho \u0111\u1ebfn khi (th\u1eddi \u0111i\u1ec3m b\u00e0i vi\u1ebft l\u00e0 2010 – ND) c\u00e1c thu\u1eadt to\u00e1n m\u1ea1nh m\u1ebd h\u01a1n v\u00e0 c\u00e1c nghi\u00ean c\u1ee9u x\u00e1c nh\u1eadn th\u00eam c\u00f3 s\u1eb5n, ch\u00fang ta n\u00ean bi\u1ebft r\u1eb1ng trong th\u1eddi gian huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c trong \u0111i\u1ec1u ki\u1ec7n gi\u00e3n m\u1ea1ch ho\u1eb7c co m\u1ea1ch d\u1eef d\u1ed9i, CO \u0111o \u0111\u01b0\u1ee3c c\u00f3 th\u1ec3 t\u00e1ch ra kh\u1ecfi m\u00f4i tr\u01b0\u1eddng \u0111\u1ed9c l\u1eadp v\u1edbi \u0111o qua \u0111\u1ed9 pha lo\u00e3ng ch\u1ec9 th\u1ecb bolus, \u0111\u1eb7c bi\u1ec7t n\u1ebfu s\u1eed d\u1ee5ng \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i vi. Trong nh\u1eefng \u0111i\u1ec1u ki\u1ec7n n\u00e0y, ch\u00fang t\u00f4i ch\u1ee7 tr\u01b0\u01a1ng s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p pha lo\u00e3ng ch\u1ea5t ch\u1ec9 th\u1ecb xuy\u00ean ph\u1ed5i qua \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i.<\/p>\n
Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, c\u00f3 xu h\u01b0\u1edbng s\u1eed d\u1ee5ng c\u00e1c h\u1ec7 th\u1ed1ng theo d\u00f5i huy\u1ebft \u0111\u1ed9ng \u2018x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u\u2019 trong c\u00e1c \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t (ICU) v\u00e0 trong c\u00e1c ph\u00f2ng m\u1ed5 \u0111\u1ec3 \u0111o li\u00ean t\u1ee5c cung l\u01b0\u1ee3ng tim (CO) trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y. Trong b\u1ed1i c\u1ea3nh n\u00e0y, “x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u” c\u00f3 ngh\u0129a l\u00e0 “\u00edt x\u00e2m l\u1ea5n h\u01a1n so v\u1edbi \u1ed1ng th\u00f4ng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i” v\u00e0 \u0111\u01b0\u1ee3c cho l\u00e0 m\u1ed9t thu\u1eadt ng\u1eef v\u00f4 \u00edch. Tuy nhi\u00ean, trong s\u1ed1 c\u00e1c thi\u1ebft b\u1ecb hi\u1ec7n c\u00f3, h\u1ec7 th\u1ed1ng FloTrac-Vigileo (FTV) (Edwards Lifesciences LLC, Irvine, CA, USA) c\u00f3 l\u1ebd x\u1ee9ng \u0111\u00e1ng v\u1edbi bi\u1ec3u t\u01b0\u1ee3ng n\u00e0y v\u00ec n\u00f3 \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf \u0111\u1ec3 ch\u1ea1y t\u1eeb b\u1ea5t k\u1ef3 \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch n\u00e0o (th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n trong ICU ho\u1eb7c \u0111ang tr\u1ea3i qua m\u1ed9t cu\u1ed9c ph\u1eabu thu\u1eadt l\u1edbn, \u00edt nh\u1ea5t l\u00e0 \u1edf Ch\u00e2u \u00c2u) v\u00e0 kh\u00f4ng c\u1ea7n hi\u1ec7u ch\u1ec9nh. Kh\u1ea3 n\u0103ng th\u1ee9 hai n\u00e0y l\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a m\u1ed9t thu\u1eadt to\u00e1n ph\u1ee9c t\u1ea1p m\u00e0 thi\u1ebft b\u1ecb s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n t\u00edch d\u1ea1ng s\u00f3ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch (APW), cho d\u00f9 thu \u0111\u01b0\u1ee3c t\u1eeb \u0111\u1ed9ng m\u1ea1ch quay hay \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i, \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u1ef7 l\u1ec7 phi tuy\u1ebfn t\u00ednh gi\u1ea3 \u0111\u1ecbnh gi\u1eefa huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch (ABP) v\u00e0 th\u1ec3 t\u00edch nh\u00e1t b\u00f3p (SV) v\u00e0 do \u0111\u00f3 \u0111\u01b0a ra \u01b0\u1edbc t\u00ednh v\u1ec1 CO. Tuy nhi\u00ean, m\u1eb7c d\u00f9 s\u1eed d\u1ee5ng \u0111\u01a1n gi\u1ea3n, \u0111\u1ed9 tin c\u1eady c\u1ee7a h\u1ec7 th\u1ed1ng n\u00e0y l\u00e0 kh\u00f4ng ch\u1eafc ch\u1eafn trong \u0111i\u1ec1u ki\u1ec7n huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh, khi li\u1ec1u l\u01b0\u1ee3ng thu\u1ed1c v\u1eadn m\u1ea1ch thay \u0111\u1ed5i nhanh ch\u00f3ng nh\u01b0ng c\u1ea7n c\u00f3 m\u1ed9t CO ch\u00ednh x\u00e1c l\u00e0 \u0111i\u1ec1u c\u1ea7n thi\u1ebft \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn c\u00e1ch qu\u1ea3n l\u00fd ph\u00f9 h\u1ee3p.<\/p>\n
Thu\u1eadt to\u00e1n FloTrac ph\u00e2n t\u00edch s\u1ef1 ph\u00e2n ph\u1ed1i th\u1ed1ng k\u00ea c\u1ee7a c\u00e1c \u0111i\u1ec3m d\u1eef li\u1ec7u c\u1ee7a ABP \u0111\u01b0\u1ee3c l\u1ea5y m\u1eabu \u1edf 100 Hz v\u00e0 d\u1ef1a tr\u00ean nguy\u00ean t\u1eafc r\u1eb1ng \u00e1p l\u1ef1c xung \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 t\u1ef7 l\u1ec7 v\u1edbi SV, \u0111\u01b0\u1ee3c \u0111o b\u1eb1ng \u0111\u1ed9 l\u1ec7ch chu\u1ea9n c\u1ee7a \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch (\u03c3AP) xung quanh \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh (MAP). \u03c3AP sau \u0111\u00f3 \u0111\u01b0\u1ee3c nh\u00e2n v\u1edbi m\u1ed9t tham s\u1ed1 t\u1ef7 l\u1ec7 b\u1eaft ngu\u1ed3n t\u1eeb m\u1ed9t ph\u01b0\u01a1ng tr\u00ecnh \u0111a th\u1ee9c \u0111a bi\u1ebfn bao g\u1ed3m d\u1eef li\u1ec7u nh\u00e2n kh\u1ea9u h\u1ecdc c\u1ee7a b\u1ec7nh nh\u00e2n, compliance c\u1ee7a \u0111\u1ed9ng m\u1ea1ch, \u0111\u1ed9 l\u1ec7ch (\u0111\u1ed1i x\u1ee9ng c\u1ee7a d\u1ea1ng s\u00f3ng) \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh cho tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch m\u00e1u v\u00e0 kurtosis (\u0111o m\u1ee9c APW \u0111\u1ea1t \u0111\u1ec9nh) \u0111\u1ec3 b\u00f9 \u0111\u1eafp v\u1ec1 s\u1ef1 kh\u00e1c bi\u1ec7t trong APW do v\u1ecb tr\u00ed huy\u1ebft m\u1ea1ch.<\/p>\n
V\u1ea5n \u0111\u1ec1 c\u01a1 b\u1ea3n c\u1ee7a c\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y l\u00e0 \u0111\u1ea3m b\u1ea3o r\u1eb1ng n\u00f3 c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh v\u00e0 bi\u1ec3u di\u1ec5n ch\u00ednh x\u00e1c nh\u1eefng t\u00ecnh hu\u1ed1ng trong \u0111\u00f3 s\u1ef1 thay \u0111\u1ed5i huy\u1ebft \u00e1p (huy\u1ebft \u00e1p t\u00e2m thu, t\u00e2m tr\u01b0\u01a1ng, trung b\u00ecnh v\u00e0 m\u1ea1ch) c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 thay \u0111\u1ed5i SV ng\u01b0\u1ee3c v\u1edbi c\u00e1c thay \u0111\u1ed5i kh\u00f4ng ph\u1ea3i s\u1ef1 thay \u0111\u1ed5i tr\u00ean. N\u00f3i c\u00e1ch kh\u00e1c, h\u1ec7 th\u1ed1ng ph\u1ea3i c\u00f3 kh\u1ea3 n\u0103ng ph\u00e2n bi\u1ec7t s\u1ef1 thay \u0111\u1ed5i huy\u1ebft \u00e1p do c\u00e1c thao t\u00e1c test th\u1ec3 t\u00edch, trong \u0111\u00f3 can thi\u1ec7p ch\u00ednh l\u00e0 nh\u1eb1m m\u1ee5c \u0111\u00edch t\u0103ng CO, v\u00e0 do \u0111\u00f3 huy\u1ebft \u00e1p th\u01b0\u1eddng ch\u1ec9 thay \u0111\u1ed5i n\u1ebfu \u0111i\u1ec1u n\u00e0y x\u1ea3y ra v\u00e0 theo c\u00f9ng m\u1ed9t h\u01b0\u1edbng, m\u1eb7c d\u00f9 \u0111\u1ed9 nh\u1ea1y t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a c\u00e1ch m\u00e0 hai bi\u1ebfn s\u1ed1 ph\u1ea3n h\u1ed3i t\u1ea5t nhi\u00ean c\u00f3 th\u1ec3 ho\u00e0n to\u00e0n kh\u00e1c nhau. Khi s\u1ef1 thay \u0111\u1ed5i c\u01a1 b\u1ea3n l\u00e0 s\u1ee9c c\u1ea3n c\u1ee7a \u0111\u1ed9ng m\u1ea1ch, nh\u01b0 khi tri\u1ec3n khai s\u1eed d\u1ee5ng thu\u1ed1c v\u1eadn m\u1ea1ch, t\u00ecnh h\u00ecnh s\u1ebd kh\u00f3 kh\u0103n h\u01a1n v\u00ec can thi\u1ec7p nh\u1eb1m m\u1ee5c \u0111\u00edch l\u00e0m t\u0103ng huy\u1ebft \u00e1p, nh\u01b0ng t\u00e1c \u0111\u1ed9ng l\u00ean SV c\u00f3 th\u1ec3 theo c\u1ea3 hai h\u01b0\u1edbng. \u0110\u00e2y l\u00e0 t\u00ecnh hu\u1ed1ng \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m nhi\u1ec1u nh\u1ea5t \u0111\u1ed1i v\u1edbi c\u00e1c thu\u1eadt to\u00e1n CO d\u1ef1a tr\u00ean \u00e1p su\u1ea5t \u0111\u1ed9ng m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t l\u00e0 n\u1ebfu ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec7u ch\u1ec9nh.<\/p>\n
Trong m\u1ed9t \u1ea5n b\u1ea3n tr\u01b0\u1edbc c\u1ee7a Critical Care, Eleftheriadis v\u00e0 c\u00e1c \u0111\u1ed3ng nghi\u1ec7p [1], nh\u1eefng ng\u01b0\u1eddi \u0111\u00e3 quan s\u00e1t th\u1ea5y nh\u1eefng thay \u0111\u1ed5i kh\u00f4ng th\u1ec3 t\u01b0\u1edfng t\u01b0\u1ee3ng \u0111\u01b0\u1ee3c trong CO khi s\u1eed d\u1ee5ng thu\u1ed1c v\u1eadn m\u1ea1ch trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng c\u1ee7a h\u1ecd, \u0111\u00e3 b\u00e1o c\u00e1o m\u1ed9t th\u00ed nghi\u1ec7m \u0111\u01a1n gi\u1ea3n nh\u01b0ng trang nh\u00e3 cho th\u1ea5y r\u1eb1ng, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ea3i qua gh\u00e9p n\u1ed1i \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, nh\u1eefng thay \u0111\u1ed5i trong ABP \u0111\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi s\u1ef1 thay \u0111\u1ed5i t\u1eebng b\u01b0\u1edbc c\u1ee7a noradrenaline d\u1eabn \u0111\u1ebfn nh\u1eefng thay \u0111\u1ed5i song song v\u1ec1 CO \u0111\u01b0\u1ee3c \u0111o b\u1eb1ng FTV th\u1ebf h\u1ec7 th\u1ee9 hai (phi\u00ean b\u1ea3n ph\u1ea7n m\u1ec1m 1.14), kh\u00f4ng xu\u1ea5t hi\u1ec7n khi CO \u0111\u01b0\u1ee3c \u0111o th\u00f4ng th\u01b0\u1eddng b\u1eb1ng \u1ed1ng th\u00f4ng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u01b0\u1ee3c pha lo\u00e3ng nhi\u1ec7t. Trong nh\u1eefng \u0111i\u1ec1u ki\u1ec7n n\u00e0y c\u1ee7a nh\u1eefng thay \u0111\u1ed5i v\u1ec1 m\u1eb7t d\u01b0\u1ee3c l\u00fd c\u1ee7a tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch m\u00e1u, \u0111\u1ed9 ch\u1ec7ch v\u00e0 gi\u1edbi h\u1ea1n th\u1ecfa thu\u1eadn c\u1ee7a FTV CO cao kh\u00f4ng th\u1ec3 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c ngang b\u1eb1ng v\u1edbi s\u1ef1 pha lo\u00e3ng b\u1eb1ng nhi\u1ec7t, v\u00e0 h\u01a1n n\u1eefa, h\u00e0m l\u01b0\u1ee3ng CO thu \u0111\u01b0\u1ee3c b\u1eb1ng hai ph\u01b0\u01a1ng ph\u00e1p tr\u1edf n\u00ean l\u1edbn h\u01a1n theo t\u1eebng b\u01b0\u1edbc t\u0103ng ABP, ch\u1ee9ng t\u1ecf r\u1eb1ng (\u00edt nh\u1ea5t l\u00e0 trong b\u1ed1i c\u1ea3nh n\u00e0y) CO do FTV \u0111o \u0111\u01b0\u1ee3c ph\u1ee5 thu\u1ed9c v\u00e0o MAP.<\/p>\n
Nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y l\u00e0m n\u1ed5i b\u1eadt th\u1ef1c t\u1ebf l\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p cung l\u01b0\u1ee3ng tim d\u1ef1a tr\u00ean \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch (APCO), \u0111\u1eb7c bi\u1ec7t khi kh\u00f4ng \u0111\u01b0\u1ee3c hi\u1ec7u chu\u1ea9n, v\u1eabn b\u1ecb \u1ea3nh h\u01b0\u1edfng m\u1ea1nh b\u1edfi c\u00e1c y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ABP v\u00e0 APW \u0111\u1ed9c l\u1eadp v\u1edbi SV v\u00e0 CO. Ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a APW, m\u1ee9c \u0111\u1ed9 ph\u1ea3n x\u1ea1 s\u00f3ng \u00e1p l\u1ef1c t\u1ea1i v\u1ecb tr\u00ed \u0111\u1ed9ng m\u1ea1ch (t\u1ee9c l\u00e0 \u0111\u1ed9ng m\u1ea1ch quay so v\u1edbi \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i), m\u1ee9c \u0111\u1ed9 v\u00e0 s\u1ef1 thay \u0111\u1ed5i nhanh ch\u00f3ng c\u1ee7a tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch v\u00e0 s\u1ef1 tu\u00e2n th\u1ee7, v\u00e0 h\u00ecnh d\u1ea1ng c\u1ee7a h\u1ec7 th\u1ed1ng \u0111\u1ed9ng m\u1ea1ch \u0111\u1ec1u c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c thu\u1eadt to\u00e1n APCO, l\u00e0m cho c\u00e1c h\u1ec7 th\u1ed1ng n\u00e0y kh\u00f4ng \u0111\u00e1ng tin c\u1eady \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ea3i qua nh\u1eefng thay \u0111\u1ed5i nhanh ch\u00f3ng v\u1ec1 ABP do thay \u0111\u1ed5i s\u1ee9c c\u1ea3n m\u1ea1ch m\u00e1u (v\u00ed d\u1ee5, trong qu\u00e1 tr\u00ecnh co m\u1ea1ch do d\u01b0\u1ee3c l\u00fd g\u00e2y ra). V\u00ec v\u1eady, m\u1eb7c d\u00f9 v\u1ec1 m\u1eb7t l\u00fd thuy\u1ebft, thu\u1eadt to\u00e1n s\u1ebd b\u00f9 tr\u1eeb cho nh\u1eefng thay \u0111\u1ed5i v\u1ec1 tr\u01b0\u01a1ng l\u1ef1c v\u00e0 v\u1ecb tr\u00ed \u0111\u1ed9ng m\u1ea1ch sau m\u1ed7i 60 gi\u00e2y ph\u00f9 h\u1ee3p v\u1edbi m\u00f4 h\u00ecnh, nh\u01b0ng c\u00f3 v\u1ebb nh\u01b0 r\u00f5 r\u00e0ng r\u1eb1ng h\u1ec7 s\u1ed1 t\u1ef7 l\u1ec7 t\u1ef1 hi\u1ec7u chu\u1ea9n b\u00f9 tr\u1eeb d\u01b0\u1edbi m\u1ee9c cho s\u1ef1 gia t\u0103ng tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch m\u00e1u v\u00e0 b\u00f9 tr\u1eeb qu\u00e1 m\u1ee9c trong \u0111i\u1ec1u ki\u1ec7n tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch m\u00e1u th\u1ea5p, l\u00e0m cho h\u1ec7 th\u1ed1ng t\u1ef7 l\u1ec7 thu\u1eadn v\u1edbi nh\u1eefng thay \u0111\u1ed5i trong ABP.<\/p>\n
C\u00f4ng b\u1eb1ng m\u00e0 n\u00f3i, ph\u1ea7n m\u1ec1m th\u1ebf h\u1ec7 th\u1ee9 hai c\u1ee7a FTV \u0111\u00e3 cho th\u1ea5y \u0111\u1ed9 ch\u00ednh x\u00e1c \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n trong \u0111i\u1ec1u ki\u1ec7n \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng ho\u1eb7c trong nh\u1eefng thay \u0111\u1ed5i v\u1ec1 th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch m\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 v\u1ec1 tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch, v\u00e0 do \u0111\u00f3 c\u00f3 th\u1ec3 h\u1eefu \u00edch trong vi\u1ec7c h\u01b0\u1edbng d\u1eabn t\u1ea3i th\u1ec3 t\u00edch (v\u00ed d\u1ee5 , trong ‘li\u1ec7u ph\u00e1p h\u01b0\u1edbng t\u1edbi m\u1ee5c ti\u00eau s\u1edbm – ‘ ho\u1eb7c t\u1ed1i \u01b0u h\u00f3a tr\u01b0\u1edbc ph\u1eabu thu\u1eadt cho ph\u1eabu thu\u1eadt t\u1ef1 ch\u1ecdn). Tuy nhi\u00ean, s\u1ef1 \u0111\u1ed3ng thu\u1eadn k\u00e9m kh\u00f4ng th\u1ec3 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ec9 ra trong c\u00e1c nghi\u00ean c\u1ee9u bao g\u1ed3m nh\u1eefng b\u1ec7nh nh\u00e2n \u1edf m\u1ee9c c\u1ef1c \u0111i\u1ec3m c\u1ee7a tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch v\u00e0 s\u1ef1 tu\u00e2n th\u1ee7 nh\u01b0 b\u1ec7nh nh\u00e2n x\u01a1 gan \u0111\u01b0\u1ee3c gh\u00e9p gan [2,3], b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m tr\u00f9ng [4], b\u1ec7nh nh\u00e2n n\u1eb7ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng d\u00f9ng thu\u1ed1c v\u1eadn m\u1ea1ch li\u1ec1u l\u1edbn. [5], v\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang ph\u1eabu thu\u1eadt tim [6], trong \u0111\u00f3 nh\u1eefng thay \u0111\u1ed5i v\u1ec1 tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch v\u00e0 s\u1ef1 tu\u00e2n th\u1ee7 l\u00e0 n\u1ed5i b\u1eadt v\u00e0 nh\u1eefng thay \u0111\u1ed5i r\u00f5 r\u00e0ng v\u1ec1 CO l\u00e0 do s\u1ef1 thay \u0111\u1ed5i trong APW [7].<\/p>\n
M\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng kh\u00e1c c\u1ea7n xem x\u00e9t khi \u0111o CO gi\u1eefa b\u1eb1ng b\u1ea5t k\u1ef3 h\u1ec7 th\u1ed1ng APCO n\u00e0o l\u00e0 v\u1ecb tr\u00ed \u0111o ABP (v\u00ed d\u1ee5, \u0111\u1ed9ng m\u1ea1ch quay so v\u1edbi \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i) c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn APW v\u00e0 do \u0111\u00f3 CO. S\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa huy\u1ebft \u00e1p trung t\u00e2m v\u00e0 ngo\u1ea1i vi \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng nh\u01b0 sau khi b\u1eafc c\u1ea7u tim ph\u1ed5i [8], trong khi ng\u1eebng tu\u1ea7n ho\u00e0n h\u1ea1 th\u00e2n nhi\u1ec7t s\u00e2u [9], trong khi h\u1ed3i s\u1ee9c tim ph\u1ed5i [10], \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c co m\u1ea1ch li\u1ec1u cao [11], v\u00e0 \u1edf b\u1ec7nh nh\u00e2n trong qu\u00e1 tr\u00ecnh t\u00e1i t\u01b0\u1edbi m\u00e1u sau khi gh\u00e9p gan [12]. S\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 ABP gi\u1eefa c\u00e1c v\u1ecb tr\u00ed kh\u00e1c nhau c\u00f3 th\u1ec3 l\u1edbn v\u00e0 trong \u0111i\u1ec1u ki\u1ec7n co m\u1ea1ch m\u1ea1nh, ABP \u0111\u1ed9ng m\u1ea1ch quay c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 th\u1ea5p ABP \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 th\u1ef1c s\u1ef1, cho gi\u00e1 tr\u1ecb CO th\u1ea5p gi\u1ea3. \u0110i\u1ec1u \u0111\u00e1ng quan t\u00e2m l\u00e0 trong nghi\u00ean c\u1ee9u c\u1ee7a Eleftheriadis v\u00e0 c\u1ed9ng s\u1ef1 [1], s\u1ef1 kh\u00e1c bi\u1ec7t l\u1edbn v\u1ec1 CO gi\u1eefa FTV v\u00e0 catheter \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh m\u1eb7c d\u00f9 th\u1ef1c t\u1ebf l\u00e0 ABP cho FTV thu \u0111\u01b0\u1ee3c t\u1eeb \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i. C\u00e1c \u0111\u1ed9ng m\u1ea1ch trung t\u00e2m tr\u1edf n\u00ean \u00edt nh\u1ea1y c\u1ea3m h\u01a1n v\u1edbi c\u00e1c bi\u1ebfn thi\u00ean \u0111\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch v\u00ec tr\u01b0\u01a1ng l\u1ef1c ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch \u0111\u00e3 cao v\u00e0 h\u1ec7 s\u1ed1 ph\u1ea3n x\u1ea1 (t\u1ef7 s\u1ed1 gi\u1eefa s\u00f3ng ph\u1ea3n x\u1ea1 v\u00e0 s\u00f3ng t\u1edbi trong mi\u1ec1n t\u1ea7n s\u1ed1) ch\u1ec9 c\u00f3 th\u1ec3 t\u0103ng l\u00ean m\u1ed9t ch\u00fat do co m\u1ea1ch m\u1ea1nh. [13]. C\u00e1c nghi\u00ean c\u1ee9u xem x\u00e9t s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 CO khi FTV \u0111\u01b0\u1ee3c k\u1ebft n\u1ed1i v\u1edbi \u0111\u1ed9ng m\u1ea1ch quay ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i \u0111\u00e3 cho th\u1ea5y c\u00e1c k\u1ebft qu\u1ea3 kh\u00e1c nhau [14,15] nh\u01b0ng n\u00eau b\u1eadt th\u1ef1c t\u1ebf l\u00e0 t\u00e1c \u0111\u1ed9ng c\u1ee7a v\u1ecb tr\u00ed \u0111\u1eb7t \u1ed1ng th\u00f4ng \u0111\u1ed9ng m\u1ea1ch kh\u00f4ng th\u1ec3 kh\u00f4ng \u0111\u00e1ng k\u1ec3 v\u00e0 thu\u1eadt to\u00e1n c\u00f3 th\u1ec3 kh\u00f4ng th\u1ec3 b\u00f9 cho nh\u1eefng thay \u0111\u1ed5i v\u1ec1 h\u00ecnh d\u1ea1ng v\u00e0 bi\u00ean \u0111\u1ed9 c\u1ee7a APW trong c\u00e1c \u0111i\u1ec1u ki\u1ec7n huy\u1ebft \u0111\u1ed9ng c\u1ef1c m\u1ea1nh.<\/p>\n
K\u1ebft lu\u1eadn, h\u1ec7 th\u1ed1ng t\u1ef1 hi\u1ec7u chu\u1ea9n ch\u1ec9 h\u1eefu \u00edch khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 theo d\u00f5i nh\u1eefng thay \u0111\u1ed5i c\u1ee7a SV trong qu\u00e1 tr\u00ecnh th\u1eed th\u00e1ch d\u1ecbch \u1edf \u0111i\u1ec1u ki\u1ec7n \u1ed5n \u0111\u1ecbnh nh\u01b0ng tr\u1edf n\u00ean k\u00e9m ch\u00ednh x\u00e1c h\u01a1n v\u1edbi nh\u1eefng thay \u0111\u1ed5i v\u1ec1 tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch m\u00e1u v\u00e0 kh\u1ea3 n\u0103ng ph\u1ea3n \u1ee9ng. Cho \u0111\u1ebfn khi c\u00e1c thu\u1eadt to\u00e1n m\u1ea1nh m\u1ebd h\u01a1n v\u00e0 c\u00e1c nghi\u00ean c\u1ee9u x\u00e1c nh\u1eadn th\u00eam \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh n\u1eb7ng c\u00f3 s\u1eb5n, ch\u00fang ta n\u00ean bi\u1ebft r\u1eb1ng trong \u0111i\u1ec1u ki\u1ec7n huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh, h\u1ec7 th\u1ed1ng ABP-CO ch\u01b0a hi\u1ec7u chu\u1ea9n c\u00f3 th\u1ec3 kh\u00e1c v\u1edbi c\u00e1c ph\u00e9p \u0111o bolus \u0111\u1ed9c l\u1eadp, \u0111\u1eb7c bi\u1ec7t n\u1ebfu s\u1eed d\u1ee5ng \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i vi v\u00ec \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 th\u1ea5p ho\u1eb7c \u0111\u00e1nh gi\u00e1 qu\u00e1 cao huy\u1ebft \u00e1p trung t\u00e2m t\u00f9y thu\u1ed9c v\u00e0o tr\u01b0\u01a1ng l\u1ef1c m\u1ea1ch. Trong nh\u1eefng \u0111i\u1ec1u ki\u1ec7n n\u00e0y, ch\u00fang t\u00f4i \u1ee7ng h\u1ed9 vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c h\u1ec7 th\u1ed1ng \u0111\u01b0\u1ee3c hi\u1ec7u chu\u1ea9n l\u1ea1i th\u01b0\u1eddng xuy\u00ean b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng pha lo\u00e3ng ch\u1ea5t ch\u1ec9 th\u1ecb qua \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i ho\u1eb7c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o.<\/h2>\n
\n
Eleftheriadis S, Galatoudis Z, Didilis V, Bougioukas I, Schon J, Heinze H, Berger KU, Heringlake M: Variations in arterial blood pressure are associated with parallel changes in FlowTrac\/Vigileo(R)- derived cardiac output measurements: a prospective comparison study. Crit Care 2009, 13:R179.<\/li>\n
Biancofi ore G, Critchley LA, Lee A, Bindi L, Bis\u00e0 M, Esposito M, Meacci L, Mozzo R, DeSimone P, Urbani L, Filipponi F: Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery. Br J Anaesth 2009, 102:47-54.<\/li>\n
Biais M, Nouette-Gaulain K, Cottenceau V, Vallet A, Cochard JF, Revel P, Sztark F: Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis. Anesth Analg 2008, 106:1480-1486, table of contents.<\/li>\n
Sakka SG, Kozieras J, Thuemer O, van Hout N: Measurement of cardiac output: a comparison between transpulmonary thermodilution and uncalibrated pulse contour analysis. Br J Anaesth 2007, 99:337-342.<\/li>\n
Compton FD, Zukunft B, Hoffmann C, Zidek W, Schaefer JH: Performance of a minimally invasive uncalibrated cardiac output monitoring system (Flotrac\/Vigileo) in haemodynamically unstable patients. Br J Anaesth 2008, 100:451-456.<\/li>\n
Mayer J, Boldt J, Schollhorn T, Rohm KD, Mengistu AM, Suttner S: Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery. Br J Anaesth 2007, 98:176-182.<\/li>\n
Mayer J, Boldt J, Poland R, Peterson A, Manecke GR Jr.: Continuous arterial pressure waveform- based cardiac output using the FloTrac\/Vigileo: a review and meta-analysis. J Cardiothorac Vasc Anesth 2009, 23:401-406.<\/li>\n
Chauhan S, Saxena N, Mehrotra S, Rao BH, Sahu M: Femoral artery pressures are more reliable than radial artery pressures on initiation of cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2000, 14:274-276.<\/li>\n
Manecke GR Jr., Parimucha M, Stratmann G, Wilson WC, Roth DM, Auger WR, Kerr KM, Jamieson SW, Kapelanski DP, Mitchell MM: Deep hypothermic circulatory arrest and the femoral-to-radial arterial pressure gradient. J Cardiothorac Vasc Anesth 2004, 18:175-179.<\/li>\n
Rivers EP, Lozon J, Enriquez E, Havstad SV, Martin GB, Lewandowski CA, Goetting MG, Rosenberg JA, Paradis NA, Nowak RM: Simultaneous radial, femoral, and aortic arterial pressures during human cardiopulmonary resuscitation. Crit Care Med 1993, 21:878-883.<\/li>\n
Dorman T, Breslow MJ, Lipsett PA, Rosenberg JM, Balser JR, Almog Y, Rosenfeld BA: Radial artery pressure monitoring underestimates central arterial pressure during vasopressor therapy in critically ill surgical patients. Crit Care Med 1998, 26:1646-1649.<\/li>\n
Arnal D, Garutti I, Perez-Pena J, Olmedilla L, Tzenkov IG: Radial to femoral arterial blood pressure differences during liver transplantation. Anaesthesia 2005, 60:766-771.<\/li>\n
Nichols WW, O\u2019Rourke MF: McDonald\u2019s Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles. 5th edition. London: Hodder Arnold; 2005.<\/li>\n
Hofer CK, Button D, Weibel L, Genoni M, Zollinger A: Uncalibrated radial and femoral arterial pressure waveform analysis for continuous cardiac output measurement: an evaluation in cardiac surgery patients. J Cardiothorac Vasc Anesth 2009 Aug 21. [Epub ahead of print].<\/li>\n
Schramm S, Albrecht E, Frascarolo P, Chassot PG, Spahn DR: Validity of an arterial pressure waveform analysis device: does the puncture site play a role in the agreement with intermittent pulmonary catheter thermodilution measurements? J Cardiothorac Vasc Anesth 2009 Aug 21.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
T\u00e1c gi\u1ea3: Luigi Camporota and Richard Beale* vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft C\u1ea1m b\u1eaby trong theo d\u00f5i huy\u1ebft \u0111\u1ed9ng d\u1ef1a tr\u00ean d\u1ea1ng s\u00f3ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch, xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y. *Correspondence: richard.beale@gstt.nhs.uk Department of Adult Critical Care – Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, St […]\n","protected":false},"author":1,"featured_media":33596,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-33592","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33592","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=33592"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33592\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/33596"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=33592"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=33592"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=33592"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}