{"id":34146,"date":"2022-10-18T14:19:27","date_gmt":"2022-10-18T07:19:27","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=34146"},"modified":"2022-10-18T14:22:11","modified_gmt":"2022-10-18T07:22:11","slug":"phu-phoi-cap-chop-nhoang-scape","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/phu-phoi-cap-chop-nhoang-scape\/","title":{"rendered":"Ph\u00f9 ph\u1ed5i ch\u1edbp nho\u00e1ng (SCAPE)"},"content":{"rendered":"

Tham kh\u1ea3o nhanh<\/h2>\n
SCAPE dx & rx checklist<\/h3>\n
C\u00e1c ph\u00e1t hi\u1ec7n l\u00e2m s\u00e0ng trung t\u00e2m c\u1ee7a SCAPE<\/strong><\/p>\n
\n
Kh\u1edfi ph\u00e1t kh\u00f3 th\u1edf d\u1eef d\u1ed9i m\u1ed9t c\u00e1ch nhanh ch\u00f3ng.<\/li>\n
Gi\u1ea3m oxy m\u00e1u.<\/li>\n
T\u0103ng huy\u1ebft \u00e1p (HATT > 160 mm v\u00e0 \/ ho\u1eb7c HA trung b\u00ecnh > 120 mm).<\/li>\n
Rales lan t\u1ecfa (\u0111\u00f4i khi c\u00f3 \u0111\u00e0m b\u1ecdt h\u1ed3ng).<\/li>\n
POCUS cho th\u1ea5y B-line lan t\u1ecfa.<\/li>\n<\/ol>\n
rx # 1: CPAP \/ BiPAP\u00a0<\/strong><\/p>\n
\n
M\u1ed9t trong hai ho\u1ea1t \u0111\u1ed9ng t\u1ed1t (m\u1ea5u ch\u1ed1t l\u00e0\u00a0\u00e1p l\u1ef1c\u00a0th\u1edf racao).<\/li>\n
Nhanh ch\u00f3ng chu\u1ea9n \u0111\u1ed9 \u00e1p l\u1ef1c, \u0111\u1ec3 nh\u1eafm m\u1ee5c ti\u00eau:<\/li>\n
CPAP ~ 15-18 cm.<\/li>\n
BiPAP ~ 18\/15 cm.<\/li>\n
N\u1ebfu kh\u00f4ng dung n\u1ea1p, h\u00e3y xem x\u00e9t IV fentanyl.<\/li>\n<\/ul>\n
rx # 2: nitroglycerine<\/strong><\/p>\n
\n
(1) Bolus 1.000-2.000 mcg trong ~ 2 ph\u00fat (v\u00ed d\u1ee5: 400-800 mcg \/ ph\u00fat trong 2,5 ph\u00fat).<\/li>\n
(2) B\u1eaft \u0111\u1ea7u truy\u1ec1n v\u1edbi t\u1ed1c \u0111\u1ed9 ~ 100-300 mcg \/ ph\u00fat.<\/li>\n
(3) T\u0103ng li\u1ec1u t\u00edch c\u1ef1c l\u00ean 800 mcg \/ ph\u00fat n\u1ebfu c\u1ea7n, nh\u1eafm m\u1ee5c ti\u00eau gi\u1ea3m huy\u1ebft \u00e1p (HATT <~ 140 mm).<\/li>\n
(4) Sau khi c\u01a1n SCAPE ch\u1ea5m d\u1ee9t, h\u00e3y t\u00edch c\u1ef1c cai nitroglycerine \u0111\u1ec3 tr\u00e1nh t\u1ee5t huy\u1ebft \u00e1p.<\/li>\n<\/ul>\n
rx # 3: n\u1ebfu t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb\u00a0<\/strong><\/p>\n
\n
Gi\u1ea3m nhanh ch\u00f3ng huy\u1ebft \u00e1p l\u00e0 \u0111i\u1ec1u c\u1ea7n thi\u1ebft (v\u00ed d\u1ee5: HATT <~ 140).<\/li>\n
CPAP \/ BiPAP c\u1ed9ng v\u1edbi truy\u1ec1n nitroglycerine\u00a0th\u01b0\u1eddng l\u00e0\u0111\u1ee7.\u00a0N\u1ebfu kh\u00f4ng, h\u00e3y xem x\u00e9t:<\/li>\n
(# 1) Clevidipine gtt (n\u00ean \u01b0u ti\u00ean) ho\u1eb7c nicardipine gtt.<\/li>\n
(# 2) Enalaprilat 1,25 mg IV (c\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i sau 15 ph\u00fat \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a l\u00e0 5 mg).<\/li>\n
(# 3) Fentanyl li\u1ec1u th\u1ea5p (n\u1ebfu \u0111au kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c ho\u1eb7c \u0111\u00f3i kh\u00ed).<\/li>\n<\/ul>\n
SCAPE vs ph\u00f9 ph\u1ed5i b\u00e1n c\u1ea5p (subacute pulmonary edema)<\/h2>\n
Sinh l\u00fd h\u1ecdc c\u1ee7a SCAPE<\/h3>\n
$\"Sinh$
Sinh l\u00fd h\u1ecdc c\u1ee7a SCAPE<\/figcaption><\/figure>\n
\n
SCAPE<\/strong> x\u1ea3y ra do m\u1ed9t\u00a0v\u00f2ng xo\u00e1y lu\u1ea9n qu\u1ea9n li\u00ean quan \u0111\u1ebfn t\u0103ng c\u01b0\u1eddng d\u00f2ng ch\u1ea3y giao c\u1ea3m (sympathetic outflow), t\u0103ng h\u1eadu t\u1ea3i qu\u00e1 m\u1ee9c v\u00e0 suy tim n\u1eb7ng d\u1ea7n.\u00a0V\u00ec SCAPE l\u00e0 m\u1ed9t v\u00f2ng xo\u00e1y lu\u1ea9n qu\u1ea9n, n\u00f3 c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n r\u1ea5t nhanh (do \u0111\u00f3 c\u00f3 thu\u1eadt ng\u1eef \u201cph\u00f9 ph\u1ed5i c\u1ea5p ch\u1edbp nho\u00e1ng \u2013 flash pulmonary edema\u201d).\u00a0V\u1edbi li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c, n\u00f3 c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c\u00a0gi\u1ea3i quy\u1ebft\u00a0r\u1ea5t nhanh.<\/li>\n
\u0110\u1eb7c \u0111i\u1ec3m sinh l\u00fd b\u1ec7nh c\u1ed1t l\u00f5i c\u1ee7a SCAPE<\/strong> l\u00e0 h\u1eadu t\u1ea3i t\u0103ng cao do co m\u1ea1ch to\u00e0n th\u00e2n v\u00e0 t\u0103ng huy\u1ebft \u00e1p.<\/li>\n
B\u1ec7nh nh\u00e2n SCAPE c\u00f3 th\u1ec3 l\u00e0 \u0111\u1eb3ng th\u1ec3 t\u00edch ho\u1eb7c gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n.\u00a0V\u1ea5n \u0111\u1ec1 l\u00e0\u00a0s\u1ef1 chuy\u1ec3n d\u1ecbchc\u1ee7a ch\u1ea5t l\u1ecfng v\u00e0o ph\u1ed5i, ch\u1ee9 kh\u00f4ng ph\u1ea3i l\u00e0 t\u0103ng th\u1ec3 tu\u1ea7n ho\u00e0n.<\/li>\n<\/ul>\n
Ph\u00f9 ph\u1ed5i b\u00e1n c\u1ea5p do qu\u00e1 t\u1ea3i d\u1ecbch (SCOPE: subacute cardionegic overload pulmonary edema)<\/h3>\n
$\"Ph\u00f9$
Ph\u00f9 ph\u1ed5i b\u00e1n c\u1ea5p<\/strong> do qu\u00e1 t\u1ea3i d\u1ecbch<\/figcaption><\/figure>\n
\n
FOSPE x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ph\u00e1t tri\u1ec3n qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch d\u1ea7n d\u1ea7n.\u00a0N\u00f3 \u0111\u01b0\u1ee3c so s\u00e1nh v\u1edbi SCAPE trong b\u1ea3ng tr\u00ean.<\/li>\n
SCAPE v\u00e0 FOSPE kh\u00f4ng lo\u1ea1i tr\u1eeb l\u1eabn nhau.\u00a0V\u00ed d\u1ee5, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 SCAPE ch\u1ed3ng l\u00ean FOSPE (t\u1ee9c l\u00e0, t\u00edch t\u1ee5 th\u1ec3 t\u00edch d\u1ea7n d\u1ea7n theo th\u1eddi gian, cu\u1ed1i c\u00f9ng \u0111\u1ea1t \u0111\u1ebfn \u0111i\u1ec3m gi\u1edbi h\u1ea1n v\u00e0 g\u00e2y ra m\u1ed9t c\u01a1n SCAPE c\u1ea5p t\u00ednh).\u00a0M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t r\u1eb1ng SCAPE v\u00e0 FOSPE \u0111\u1ea1i di\u1ec7n cho hai d\u1ea1ng c\u1ef1c \u0111oan c\u1ee7a ph\u00f9 ph\u1ed5i, v\u1edbi m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n n\u1eb1m \u1edf gi\u1eefa.\u00a0(\u00a029478124<\/a>)<\/li>\n
Ph\u00e2n bi\u1ec7t SCAPE v\u00e0 FOSPE l\u00e0 \u0111i\u1ec1u quan tr\u1ecdng v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng, v\u00ec c\u00e1ch \u0111i\u1ec1u tr\u1ecb l\u00e0 kh\u00e1c nhau.<\/li>\n<\/ul>\n
Danh ph\u00e1p (nomenclature)<\/h3>\n
SCAPE \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn v\u1edbi nhi\u1ec1u thu\u1eadt<\/span>\u00a0ng\u1eef kh\u00e1c nhau trong c\u00e1c t\u00e0i li\u1ec7u khoa h\u1ecdc, \u0111\u00e1ng ch\u00fa \u00fd nh\u1ea5t l\u00e0:<\/p>\n
\n
Ph\u00f9 ph\u1ed5i c\u1ea5p ch\u1edbp nho\u00e1ng<\/strong>(thu\u1eadt ng\u1eef n\u00e0y ng\u00e0y c\u00e0ng tr\u1edf n\u00ean \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n).<\/li>\n
Suy tim c\u1ea5p do t\u0103ng huy\u1ebft \u00e1p(thu\u1eadt ng\u1eef \u0111\u01b0\u1ee3c \u01b0a th\u00edch trong c\u00e1c t\u1ea1p ch\u00ed v\u1ec1 t\u0103ng huy\u1ebft \u00e1p).<\/li>\n
SCAPE(ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u trong c\u00e1c t\u1ea1p ch\u00ed y h\u1ecdc c\u1ea5p c\u1ee9u v\u00e0 h\u1ed3i s\u1ee9c).<\/li>\n<\/ul>\n
SCAPE l\u00e0 thu\u1eadt ng\u1eef \u0111\u01b0\u1ee3c \u01b0a th\u00edch v\u00ec n\u00f3 r\u00f5 r\u00e0ng v\u00e0 duy nh\u1ea5t.<\/p>\n
B\u1ec7nh nh\u00e2n SCAPE th\u01b0\u1eddng \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau chu\u1ea9n c\u1ee7a \u201cc\u01a1n t\u0103ng huy\u1ebft \u00e1p c\u1ea5p c\u1ee9u\u201d (t\u1ee9c l\u00e0 t\u0103ng huy\u1ebft \u00e1p n\u1eb7ng c\u1ed9ng v\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 quan \u0111\u00edch).\u00a0Tuy nhi\u00ean, SCAPE\u00a0\u0111\u1ea1i di\u1ec7n cho m\u1ed9t th\u1ef1c th\u1ec3 duy nh\u1ea5t \u0111\u00f2i h\u1ecfi m\u1ed9t li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb\u00a0\u0111\u1ed9c nh\u1ea5t t\u01b0\u01a1ng \u1ee9ng.\u00a0V\u00ed d\u1ee5, SCAPE ph\u00e1t tri\u1ec3n r\u1ea5t nhanh \u0111\u1ebfn m\u1ee9c b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 nhanh ch\u00f3ng h\u1ea1 huy\u1ebft \u00e1p xu\u1ed1ng huy\u1ebft \u00e1p n\u1ec1n c\u1ee7a h\u1ecd (kh\u00f4ng gi\u1ed1ng nh\u01b0 nhi\u1ec1u b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p c\u1ea5p c\u1ee9u, nh\u1eefng ng\u01b0\u1eddi c\u00f3 huy\u1ebft \u00e1p t\u0103ng\u00a0d\u1ea7n v\u00e0 do \u0111\u00f3 y\u00eau c\u1ea7u\u00a0li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb gi\u1ea3m\u00a0d\u1ea7n d\u1ea7n\u00a0).\u00a0\u00a0T\u00ecm hi\u1ec3u th\u00eam v\u1ec1 t\u0103ng huy\u1ebft \u00e1p c\u1ea5p c\u1ee9u\u00a0 t\u1ea1i \u0111\u00e2y<\/a>\u00a0.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n<\/h2>\n
X\u00e1c \u0111\u1ecbnh c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a SCAPE<\/h3>\n
Kh\u1edfi ph\u00e1t t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p m\u1ed9t c\u00e1ch nhanh ch\u00f3ng(v\u00ed d\u1ee5, th\u01b0\u1eddng trong v\u00f2ng < 6 gi\u1edd).<\/p>\n
Th\u1edf nhanh v\u00e0 kh\u00f3 th\u1edf r\u00f5 r\u1ec7t.<\/p>\n
Gi\u1ea3m oxy m\u00e1u.<\/p>\n
T\u0103ng huy\u1ebft \u00e1p (th\u01b0\u1eddng HATT > 160 mm v\u00e0 \/ ho\u1eb7c MAP > 120 mm).\u00a0(\u00a0 31327485<\/a>,\u00a0 29776826<\/a>\u00a0)<\/p>\n
Ran \u1ea9m lan t\u1ecfa.<\/p>\n
C\u00f3 th\u1ec3 th\u1ea5y \u0111\u00e0m b\u1ecdt h\u1ed3ng.<\/p>\n
C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a ho\u1ea1t h\u00f3a giao c\u1ea3m:<\/p>\n
\n
V\u00e3 m\u1ed3 h\u00f4i, xanh xao, c\u00f3 v\u1ebb c\u1ef1c k\u1ef3 kh\u00f4ng \u1ed5n.<\/li>\n
Nh\u1ecbp tim nhanh.<\/li>\n
K\u00edch \u0111\u1ed9ng.<\/li>\n<\/ul>\n
B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 ti\u1ec1n\u00a0s\u1eed c\u00e1c \u0111\u1ee3t SCAPE t\u00e1i ph\u00e1t.<\/p>\n
POCUS<\/h3>\n
Ngo\u00e0i b\u1ec7nh s\u1eed v\u00e0 th\u0103m kh\u00e1m, POCUS l\u00e0 c\u00f4ng c\u1ee5 m\u1ea1nh nh\u1ea5t \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n SCAPE.<\/p>\n
Si\u00eau \u00e2m ph\u1ed5i:<\/p>\n
\n
Ph\u00f9 ph\u1ed5i do tim t\u1ea1o ra m\u1ed9t ki\u1ec3u B-line lan t\u1ecfa\u00a0kh\u1eafp l\u1ed3ng ng\u1ef1c, v\u1edbi b\u1ec1 m\u1eb7t m\u00e0ng ph\u1ed5i m\u1ecfng (kh\u00f4ng gi\u1ed1ng nh\u01b0 ph\u00f9 ph\u1ed5i kh\u00f4ng do tim, th\u01b0\u1eddng g\u00e2y ra\u00a0s\u1ef1\u00a0ph\u00e2n b\u1ed1\u00a0loang l\u1ed5\u00a0c\u1ee7a B-line v\u00e0\u00a0b\u1ec1 m\u1eb7t\u00a0m\u00e0ng ph\u1ed5i\u00a0d\u00e0y l\u00ean\u00a0bao g\u1ed3m nh\u1eefng m\u1ea3ng\u00a0\u0111\u00f4ng \u0111\u1eb7c d\u01b0\u1edbi\u00a0m\u00e0ng ph\u1ed5i\u00a0).\u00a0Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i hai b\u00ean \u00edt c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 th\u00eam cho ch\u1ea9n \u0111o\u00e1n ph\u00f9 ph\u1ed5i do tim.<\/li>\n
Si\u00eau \u00e2m c\u1ef1c k\u1ef3 nh\u1ea1y \u0111\u1ed1i v\u1edbi ph\u00f9 ph\u1ed5i do tim.\u00a0N\u1ebfu kh\u00f4ng nh\u00ecn th\u1ea5y B-line lan t\u1ecfa \u1edf b\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf c\u1ea5p, ph\u00f9 ph\u1ed5i do tim c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c\u00a0lo\u1ea1i tr\u1eeb ngay l\u1eadp t\u1ee9c l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y kh\u00f3 th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n<\/ul>\n
Si\u00eau \u00e2m tim th\u01b0\u1eddng ti\u1ebft l\u1ed9 m\u1ed9t s\u1ed1 d\u1ea1ng suy tim, v\u00ed d\u1ee5:<\/p>\n
\n
Suy tim t\u00e2m thu, gi\u1ea3m ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i.<\/li>\n
Suy tim t\u00e2m tr\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c g\u1ee3i \u00fd b\u1edfi ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i v\u00e0 t\u00e2m nh\u0129 tr\u00e1i gi\u00e3n.<\/li>\n<\/ul>\n
L\u01b0u \u00fd r\u1eb1ng b\u1ec7nh nh\u00e2n SCAPE c\u00f3 th\u1ec3 b\u1ecb gi\u1ea3m th\u1ec3 t\u00edch, t\u0103ng th\u1ec3 t\u00edch ho\u1eb7c \u0111\u1eb3ng th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n.\u00a0Do \u0111\u00f3, IVC s\u1ebd kh\u00f4ng nh\u1ea5t thi\u1ebft b\u1ecb d\u00e3n (b\u1ec7nh nh\u00e2n c\u0169ng kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i c\u00f3 t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i).<\/p>\n
X-quang ng\u1ef1c<\/h3>\n
X-quang ng\u1ef1c c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 m\u1ed9t c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n.\u00a0Tuy nhi\u00ean, X quang \u00edt nh\u1ea1y h\u01a1n so v\u1edbi si\u00eau \u00e2m ph\u1ed5i \u0111\u1ed1i v\u1edbi ph\u00f9 ph\u1ed5i c\u1ea5p.\u00a0M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n b\u1ecb SCAPE c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 b\u1ea5t th\u01b0\u1eddng r\u00f5 r\u00e0ng tr\u00ean X-quang ng\u1ef1c.<\/p>\n
C\u00e1c d\u1ea5u hi\u1ec7u tr\u00ean X-quang ng\u1ef1c c\u00f3 th\u1ec3 bao g\u1ed3m:<\/p>\n
\n
Th\u00e2m nhi\u1ec5m hai b\u00ean, m\u1ecbn t\u1eadp trung \u1edf v\u00f9ng r\u1ed1n ph\u1ed5i (\u201cph\u00f9 ph\u1ed5i c\u00e1nh d\u01a1i\u201d).<\/li>\n
Kerley B-lines (d\u1ecbch trong v\u00e1ch li\u00ean th\u00f9y g\u00e2y ra c\u00e1c \u0111\u01b0\u1eddng th\u1eb3ng vu\u00f4ng g\u00f3c v\u1edbi m\u00e0ng ph\u1ed5i).<\/li>\n
Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i.<\/li>\n
Kh\u00f4ng c\u00f3 ch\u1ea9n \u0111o\u00e1n thay th\u1ebf (v\u00ed d\u1ee5: kh\u00f4ng c\u00f3 tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i ho\u1eb7c vi\u00eam ph\u1ed5i th\u00f9y).<\/li>\n<\/ul>\n
C\u1ea1m b\u1eaby ch\u1ea9n \u0111o\u00e1n: c\u00e1c d\u1ea1ng suy h\u00f4 h\u1ea5p kh\u00e1c g\u00e2y t\u0103ng huy\u1ebft \u00e1p<\/h3>\n
B\u1ea5t k\u1ef3 d\u1ea1ng suy h\u00f4 h\u1ea5p n\u1eb7ng n\u00e0o c\u0169ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn \u0111au \u0111\u1edbn v\u00e0 t\u0103ng huy\u1ebft \u00e1p.\u00a0Do \u0111\u00f3, \u0111\u1eebng cho r\u1eb1ng s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a suy h\u00f4 h\u1ea5p c\u1ed9ng v\u1edbi t\u0103ng huy\u1ebft \u00e1p nh\u1ea5t thi\u1ebft c\u00f3 ngh\u0129a l\u00e0 SCAPE.<\/p>\n
Trong nh\u1eefng t\u00ecnh hu\u1ed1ng kh\u00f4ng ch\u1eafc ch\u1eafn, b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb SCAPE \u0111\u1ed3ng th\u1eddi \u0111i\u1ec1u tra c\u00e1c v\u1ea5n \u0111\u1ec1 kh\u00e1c l\u00e0 h\u1ee3p l\u00fd.<\/p>\n
M\u1ed9t trong nh\u1eefng \u0111i\u1ec3m n\u1ed5i b\u1eadt c\u1ee7a SCAPE l\u00e0 c\u1ea3i thi\u1ec7n nhanh ch\u00f3ng v\u1edbi li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb.\u00a0\u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng h\u1ed3i ph\u1ee5c nhanh, h\u00e3y \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn c\u00e1c v\u1ea5n \u0111\u1ec1 thay th\u1ebf ho\u1eb7c b\u1ed5 sung, v\u00ed d\u1ee5:<\/p>\n
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Ch\u1ea9n \u0111o\u00e1n sai (b\u1ec7nh nh\u00e2n ARDS ch\u1ee9 kh\u00f4ng ph\u1ea3i ph\u00f9 ph\u1ed5i do tim).<\/li>\n
B\u1ec7nh n\u1ec1n (ph\u00f9 ph\u1ed5i do tim do STEMI c\u1ea5p t\u00ednh ho\u1eb7c tr\u00e0o ng\u01b0\u1ee3c van tim)<\/li>\n<\/ul>\n
BNP (brain natriuretic peptide)<\/h3>\n
Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y BNP b\u1ed5 sung th\u00f4ng tin l\u00e2m s\u00e0ng \u1edf tr\u00ean v\u00e0 ngo\u00e0i s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng v\u00e0 POCUS cho b\u1ec7nh nh\u00e2n suy tim.\u00a0(\u00a029887195<\/a>)\u00a0\u00a0\u0110i\u1ec1u n\u00e0y\u00a0\u0111\u1eb7c bi\u1ec7t\u00a0\u0111\u00fang v\u1edbi b\u1ec7nh nh\u00e2n SCAPE, trong \u0111\u00f3 ch\u1ea9n \u0111o\u00e1n th\u01b0\u1eddng kh\u00f4ng qu\u00e1 kh\u00f3 \u0111\u1ec3 nh\u1eadn ra.<\/p>\n
V\u1ec1 m\u1eb7t th\u1ef1c t\u1ebf, th\u1eddi gian tr\u1edf v\u1ec1 (turn-around time) c\u1ee7a BNP qu\u00e1 d\u00e0i \u0111\u1ec3 c\u00f3 th\u1ec3 h\u1eefu \u00edch v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng cho vi\u1ec7c qu\u1ea3n l\u00fd ngay t\u1ea1i gi\u01b0\u1eddng c\u1ee7a SCAPE.<\/p>\n
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SCAPE l\u00e0 m\u1ed9t\u00a0ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng t\u1ea1i gi\u01b0\u1eddng b\u1ec7nh, ph\u1ea3i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong v\u00f2ng v\u00e0i ph\u00fat (tr\u00ean c\u01a1 s\u1edf b\u1ec7nh s\u1eed, th\u0103m kh\u00e1m v\u00e0 si\u00eau \u00e2m POCUS).<\/li>\n<\/ul>\n
Y\u1ebfu t\u1ed1 k\u00edch ph\u00e1t SCAPE<\/h2>\n
SCAPE th\u01b0\u1eddng l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a m\u1ed9t b\u1ec7nh n\u1ec1n s\u1eb5n c\u00f3 b\u00ean d\u01b0\u1edbi k\u00e8m m\u1ed9t y\u1ebfu t\u1ed1 k\u00edch ph\u00e1t c\u1ea5p t\u00ednh.\u00a0Ngay c\u1ea3 sau khi ch\u1ea9n \u0111o\u00e1n SCAPE \u0111\u00e3 r\u00f5 r\u00e0ng, m\u1ed9t b\u1ec7nh l\u00fd c\u1ea5p t\u00ednh n\u00e0o \u0111\u00f3 g\u00e2y ra SCAPE c\u0169ng n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t (v\u00ed d\u1ee5, nh\u1ed3i m\u00e1u c\u01a1 tim ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng van c\u1ea5p t\u00ednh).<\/p>\n
Th\u01b0\u1eddng c\u00f3 m\u1ed9t b\u1ec7nh n\u1ec1n s\u1eb5n c\u00f3 b\u00ean d\u01b0\u1edbi c\u1ee7a SCAPE<\/h3>\n
Suy th\u1ea5t tr\u00e1i m\u1ea1n t\u00ednh(\u0111\u1eb7c bi\u1ec7t l\u00e0 suy tim t\u00e2m tr\u01b0\u01a1ng).<\/p>\n
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Ng\u01b0\u1ee3c l\u1ea1i,\u00a0ch\u1ee9c n\u0103ng th\u1ea5t ph\u1ea3i b\u1ea3o t\u1ed3n c\u00f3 th\u1ec3 khi\u1ebfn b\u1ec7nh nh\u00e2n b\u1ecb SCAPE (n\u1ebfu th\u1ea5t ph\u1ea3i ho\u1ea1t \u0111\u1ed9ng k\u00e9m h\u01a1n t\u00e2m th\u1ea5t tr\u00e1i, \u0111i\u1ec1u n\u00e0y s\u1ebd g\u00e2y t\u00edch t\u1ee5 d\u1ecbch trong ph\u1ed5i).<\/li>\n<\/ul>\n
Ti\u1ec1n s\u1eed\u00a0t\u0103ng huy\u1ebft \u00e1p trong ~ 90% b\u1ec7nh nh\u00e2n (\u0111\u1eb7c bi\u1ec7t l\u00e0 t\u0103ng huy\u1ebft \u00e1p kh\u00f4ng \u1ed5n \u0111\u1ecbnh).\u00a0(\u00a0 27825693<\/a>\u00a0)<\/p>\n
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H\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn n\u00f3i ri\u00eang c\u00f3 khuynh h\u01b0\u1edbng d\u1ec5 m\u1eafc SCAPE (m\u1ed9t d\u1ea1ng k\u1ebft h\u1ee3p \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 h\u1ed9i ch\u1ee9ng Pickering).\u00a0(\u00a0 33563668<\/a>\u00a0)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
C\u00e1c y\u1ebfu t\u1ed1 k\u00edch ho\u1ea1t c\u1ea5p t\u00ednh c\u1ee7a SCAPE c\u00f3 th\u1ec3 bao g\u1ed3m<\/h3>\n
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Kh\u00f4ng tu\u00e2n th\u1ee7 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p (\u0111\u1eb7c bi\u1ec7t l\u00e0 thu\u1ed1c gi\u00e3n m\u1ea1ch nh\u01b0 \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin).<\/li>\n
Qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch (v\u00ed d\u1ee5, b\u1ecf l\u1ee1 c\u00e1c bu\u1ed5i ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, kh\u00f4ng tu\u00e2n th\u1ee7 thu\u1ed1c l\u1ee3i ti\u1ec3u).<\/li>\n
Ng\u1ed9 \u0111\u1ed9c giao c\u1ea3m.<\/li>\n
Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p t\u00ednh.<\/li>\n
G\u1eafng s\u1ee9c, c\u0103ng th\u1eb3ng ho\u1eb7c lo l\u1eafng.\u00a0(\u00a0 31472891<\/a>)<\/li>\n
Nguy\u00ean nh\u00e2n hi\u1ebfm g\u1eb7p c\u1ee7a suy tim c\u1ea5p (v\u00ed d\u1ee5, h\u1edf van c\u1ea5p t\u00ednh ho\u1eb7c b\u1ec7nh c\u01a1 tim do virus).<\/li>\n<\/ul>\n
Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/h2>\n
D\u1ea5u hi\u1ec7u ti\u00eau chu\u1ea9n c\u1ee7a SCAPE l\u00e0 nhanh ch\u00f3ng x\u1ea5u \u0111i, nh\u01b0ng \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c c\u00f3 th\u1ec3 nhanh ch\u00f3ng \u0111\u1ea3o ng\u01b0\u1ee3c qu\u00e1 tr\u00ecnh n\u00e0y.\u00a0B\u1ed1n nguy\u00ean t\u1eafc c\u1ed1t l\u00f5i c\u00f3 th\u1ec3 h\u1eefu \u00edch \u0111\u1ec3 \u0111\u1ecbnh h\u01b0\u1edbng chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ed5ng th\u1ec3.<\/p>\n
Nguy\u00ean t\u1eafc s\u1ed1 1: \u01b0u th\u1ebf c\u1ee7a \u00e1p l\u1ef1c d\u01b0\u01a1ng<\/h3>\n
Can thi\u1ec7p quan tr\u1ecdng nh\u1ea5t l\u00e0 BiPAP ho\u1eb7c CPAP (c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng).\u00a0T\u1eeb b\u1eb1ng ch\u1ee9ng ch\u1ee9ng minh, nh\u1eefng can thi\u1ec7p n\u00e0y v\u01b0\u1ee3t tr\u1ed9i h\u01a1n b\u1ea5t k\u1ef3 can thi\u1ec7p n\u00e0o kh\u00e1c trong SCAPE.<\/p>\n
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C\u00e1c li\u1ec7u ph\u00e1p n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh trong nhi\u1ec1u nghi\u00ean c\u1ee9u RCT v\u00e0 ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p \u0111\u1ec3 tr\u00e1nh \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 t\u1eed vong (b\u1ea3ng b\u00ean d\u01b0\u1edbi).<\/li>\n<\/ul>\n
T\u1ea5t c\u1ea3 c\u00e1c n\u1ed7 l\u1ef1c c\u00f3 th\u1ec3 n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 d\u00f9ng CPAP \/ BiPAP, v\u00ed d\u1ee5:<\/p>\n
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H\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n \u0111\u1ec3 khuy\u1ebfn kh\u00edch s\u1ef1 tu\u00e2n th\u1ee7.<\/li>\n
Ban \u0111\u1ea7u nh\u1eb9 nh\u00e0ng gi\u1eef m\u1eb7t n\u1ea1 tr\u00ean m\u1eb7t b\u1ec7nh nh\u00e2n.<\/li>\n
S\u1eed d\u1ee5ng thu\u1ed1c \u0111\u1ec3 gi\u1ea3m t\u00ecnh tr\u1ea1ng \u0111\u00f3i kh\u00ed v\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng dung n\u1ea1p CPAP \/ BiPAP.<\/li>\n<\/ul>\n
$\"S\u1eed$
S\u1eed d\u1ee5ng thu\u1ed1c \u0111\u1ec3 gi\u1ea3m t\u00ecnh tr\u1ea1ng \u0111\u00f3i kh\u00ed v\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng dung n\u1ea1p CPAP \/ BiPAP.<\/figcaption><\/figure>\n
Nguy\u00ean t\u1eafc s\u1ed1 2: ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p (h\u1eadu t\u1ea3i)<\/h3>\n
Huy\u1ebft \u00e1p cao qu\u00e1 m\u1ee9c l\u00e0m t\u0103ng g\u00e1nh n\u1eb7ng l\u00ean t\u00e2m th\u1ea5t tr\u00e1i, th\u00fac \u0111\u1ea9y d\u1ecbch \u0111i v\u00e0o ph\u1ed5i.\u00a0\u0110\u00e2y l\u00e0 \u0111i\u1ec1u c\u01a1 b\u1ea3n \u0111\u1ed1i v\u1edbi sinh l\u00fd b\u1ec7nh c\u1ee7a SCAPE.\u00a0V\u00ec v\u1eady, m\u1ed9t trong nh\u1eefng m\u1ee5c ti\u00eau thi\u1ebft y\u1ebfu c\u1ee7a \u0111i\u1ec1u tr\u1ecb l\u00e0 l\u00e0m gi\u1ea3m nhanh huy\u1ebft \u00e1p.<\/p>\n
Kh\u00f4ng c\u00f3 m\u1ee5c ti\u00eau huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 r\u00e0ng, nh\u01b0ng m\u1ee5c ti\u00eau chung c\u00f3 th\u1ec3 l\u00e0 gi\u1ea3m nhanh huy\u1ebft \u00e1p t\u00e2m thu xu\u1ed1ng <~ 140 mmHg.\u00a0(\u00a028149030<\/a>,\u00a0 27262665<\/a>\u00a0)\u00a0\u00a0Tuy nhi\u00ean, huy\u1ebft \u00e1p trung b\u00ecnh ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng th\u1ef1c s\u1ef1 c\u00f3 th\u1ec3 l\u00e0 m\u1ee5c ti\u00eau t\u1ed1t h\u01a1n, v\u00ec ch\u00fang c\u00f3 t\u01b0\u01a1ng quan ch\u1eb7t ch\u1ebd h\u01a1n v\u1edbi s\u1ee9c c\u1ea3n m\u1ea1ch m\u00e1u h\u1ec7 th\u1ed1ng.\u00a0(\u00a0 33611627<\/a>\u00a0,\u00a0 32278569<\/a>\u00a0)<\/p>\n
C\u00e1c li\u1ec7u ph\u00e1p h\u00e0ng \u0111\u1ea7u \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p l\u00e0\u00a0t\u1ed1i \u0111a h\u00f3a \u00e1p l\u1ef1c\u00a0BiPAP\/CPAP\u00a0v\u00e0 t\u1ed1i \u0111a h\u00f3a\u00a0li\u1ec1u truy\u1ec1n\u00a0nitroglycerine.\u00a0Ph\u1ea7n\u00a0l\u1edbn\u00a0b\u1ec7nh nh\u00e2n SCAPE c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u1ea1 huy\u1ebft \u00e1p b\u1eb1ng c\u00e1ch t\u1ed1i \u01b0u h\u00f3a hai li\u1ec7u ph\u00e1p n\u00e0y.<\/p>\n
Nicardipineho\u1eb7c\u00a0clevidipine\u00a0r\u1ea5t h\u1eefu \u00edch trong t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb:<\/p>\n
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C\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch n\u00e0y l\u00e0 thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u1ed9ng m\u1ea1ch m\u1ea1nh h\u01a1n nitroglycerine, v\u00ec v\u1eady ch\u00fang c\u00f3 th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi nitroglycerine.\u00a0(\u00a0 33358327<\/a>)\u00a0\u00a0 Ch\u00fang c\u0169ng c\u00f3 th\u1ec3 l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn h\u1eefu \u00edch \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng sildenafil ho\u1eb7c tadalafil – nh\u1eefng ng\u01b0\u1eddi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi nitroglycerine.<\/li>\n
Clevidipine l\u00e0 l\u00fd t\u01b0\u1edfng, do th\u1eddi gian b\u00e1n h\u1ee7y ng\u1eafn h\u01a1n v\u00e0 c\u00f3 b\u1eb1ng ch\u1ee9ng m\u1ea1nh h\u01a1n trong suy tim c\u1ea5p.\u00a0(\u00a0 20412469<\/a>,\u00a0 24655702<\/a>\u00a0)<\/li>\n
Nicardipine c\u00f3 th\u1eddi gian b\u00e1n h\u1ee7y d\u00e0i h\u01a1n, do \u0111\u00f3 c\u00f3 nguy c\u01a1 g\u00e2y h\u1ea1 huy\u1ebft \u00e1p qu\u00e1 m\u1ee9c (\u0111\u1eb7c bi\u1ec7t khi SCAPE c\u01a1 b\u1ea3n gi\u1ea3m t\u00e1c d\u1ee5ng).<\/li>\n<\/ul>\n
Enalaprilat IV(1,25 mg, c\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i m\u1ed7i 15 ph\u00fat \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a l\u00e0 5 mg) l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn kh\u00e1c cho t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb, nh\u01b0ng nhu c\u1ea7u th\u1ef1c s\u1ef1\u00a0kh\u00f4ng ph\u1ed5 bi\u1ebfn.\u00a0(\u00a0 28032307<\/a>\u00a0,\u00a0 8822986<\/a>\u00a0,\u00a0 27262665<\/a>\u00a0).\u00a0Captopril \u0111\u01b0\u1eddng u\u1ed1ng \u00edt \u0111\u01b0\u1ee3c mong mu\u1ed1n h\u01a1n, v\u00ec n\u00f3 \u0111\u00f2i h\u1ecfi ph\u1ea3i lo\u1ea1i b\u1ecf m\u1eb7t n\u1ea1 BiPAP ho\u1eb7c CPAP.<\/p>\n
Nguy\u00ean t\u1eafc # 3:\u00a0Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng\u00a0thu\u1ed1c ch\u1eb9n beta<\/h3>\n
Thu\u1ed1c ch\u1eb9n b\u00eata s\u1ebd l\u00e0m gi\u1ea3m ch\u1ee9c n\u0103ng b\u01a1m, v\u00ec v\u1eady ch\u00fang th\u01b0\u1eddng b\u1ecb\u00a0ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnhtrong b\u1ec7nh c\u1ea3nh ph\u00f9 ph\u1ed5i c\u1ea5p m\u1ea5t b\u00f9 do tim.\u00a0Kh\u1ea3 n\u0103ng co b\u00f3p gi\u1ea3m c\u00f3 th\u1ec3 khi\u1ebfn t\u00e2m th\u1ea5t suy n\u1eb7ng h\u01a1n, d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng ph\u00f9 ph\u1ed5i n\u1eb7ng h\u01a1n.<\/p>\n
Thu\u1ed1c ch\u1eb9n beta\u00a0kh\u00f4ng n\u00ean\u00a0\u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ed1 g\u1eafng ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n SCAPE.<\/p>\n
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V\u1ea5n \u0111\u1ec1 sinh l\u00fd b\u1ec7nh quan tr\u1ecdng trong SCAPE l\u00e0 h\u1eadu t\u1ea3i qu\u00e1 m\u1ee9c, c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng\u00a0thu\u1ed1c gi\u00e3n m\u1ea1ch.<\/li>\n<\/ul>\n
H\u00e3y nh\u1edb r\u1eb1ng inotropes d\u01b0\u01a1ng (v\u00ed d\u1ee5, dobutamine) \u0111\u00f4i khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ki\u1ec3m so\u00e1t ph\u00f9 ph\u1ed5i do tim!\u00a0Inotropes \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u00e1p th\u1ea5p h\u01a1n so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n SCAPE (nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y th\u01b0\u1eddng g\u1eb7p\u00a0v\u1ea5n \u0111\u1ec1 v\u1ec1\u00a0m\u00e1y b\u01a1mh\u01a1n l\u00e0\u00a0v\u1ea5n \u0111\u1ec1 v\u1ec1\u00a0h\u1eadu t\u1ea3i\u00a0).\u00a0Tuy nhi\u00ean, \u0111i\u1ec1u n\u00e0y s\u1ebd nh\u1ea5n m\u1ea1nh kh\u00e1i ni\u1ec7m r\u1eb1ng\u00a0thu\u1ed1c ch\u1eb9n beta kh\u00f4ng c\u00f3 l\u1ee3i trong b\u1ec7nh ph\u00f9 ph\u1ed5i do tim m\u1ea5t b\u00f9\u00a0.<\/p>\n
Nguy\u00ean t\u1eafc s\u1ed1 4: \u0110\u1ec3 \u00fd khi SCAPE \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1eaft c\u01a1n<\/h3>\n
N\u1ebfu \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p, SCAPE s\u1ebd \u0111\u01b0\u1ee3c c\u1eaft c\u01a1n nhanh ch\u00f3ng – v\u00f2ng xo\u00e1y lu\u1ea9n qu\u1ea9n s\u1ebd ch\u1ea5m d\u1ee9t v\u00e0 b\u1ec7nh nh\u00e2n s\u1ebd c\u1ea3i thi\u1ec7n.\u00a0C\u00e1ch r\u00f5 r\u00e0ng nh\u1ea5t \u0111\u1ec3 bi\u1ebft \u0111i\u1ec1u n\u00e0y \u0111ang x\u1ea3y ra th\u01b0\u1eddng l\u00e0 khi huy\u1ebft \u00e1p b\u1eaft \u0111\u1ea7u gi\u1ea3m nhanh.\u00a0X\u1eed tr\u00ed bao g\u1ed3m:<\/p>\n
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(1) Nhanh ch\u00f3ng h\u1ea1 li\u1ec1u nitroglycerine truy\u1ec1n v\u00e0 \u00e1p l\u1ef1c CPAP \/ BiPAP (trong khi theo d\u00f5i SCAPE t\u00e1i ph\u00e1t).<\/li>\n
(2) Xem x\u00e9t b\u1ea5t k\u1ef3 y\u1ebfu t\u1ed1 k\u00edch ph\u00e1t SCAPE n\u00e0o v\u00e0 \u0111i\u1ec1u tr\u1ecb ch\u00fang (v\u00ed d\u1ee5: kh\u00f4ng tu\u00e2n th\u1ee7 thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p, qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch).<\/li>\n<\/ul>\n
(Th\u1ea3o lu\u1eadn th\u00eam v\u1ec1 hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y\u00a0 \u1edf \u0111\u00e2y<\/a>.)<\/p>\n
CPAP ho\u1eb7c BiPAP<\/h2>\n
Nh\u1eefng \u0111i\u1ec1u c\u01a1 b\u1ea3n<\/h3>\n
\u00c1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf d\u01b0\u01a1ng \u0111\u1ea1t \u0111\u01b0\u1ee3c\u00a0m\u1ee9c gi\u1ea3m\u00a0ngay l\u1eadp t\u1ee9c v\u00e0<\/span> c\u00f3 th\u1ec3 chu\u1ea9n\u00a0\u0111\u1ed9 \u0111\u01b0\u1ee3c\u00a0(titratable) \u1edf c\u1ea3 ti\u1ec1n t\u1ea3i v\u00e0 h\u1eadu t\u1ea3i c\u1ee7a tim.<\/p>\n
C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng CPAP ho\u1eb7c BiPAP – bi\u1ec7n ph\u00e1p can thi\u1ec7p ch\u1ee7 y\u1ebfu l\u00e0 l\u00e0m t\u0103ng\u00a0\u00e1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf trung b\u00ecnh \u2013 mean airway pressure.<\/p>\n
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CPAP: \u00c1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf trung b\u00ecnh b\u1eb1ng v\u1edbi \u00e1p l\u1ef1c c\u00e0i \u0111\u1eb7t c\u1ee7a CPAP.<\/li>\n
BiPAP: \u00c1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf trung b\u00ecnh cao h\u01a1n m\u1ed9t ch\u00fat so v\u1edbi \u00e1p su\u1ea5t th\u1edf ra (ePAP).\u00a0V\u00ed d\u1ee5, v\u1edbi BiPAP \u0111\u1eb7t \u1edf 15 cm \/ 10 cm, \u00e1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf trung b\u00ecnh c\u00f3 th\u1ec3 \u1edf \u0111\u00e2u \u0111\u00f3 kho\u1ea3ng ~ 12 cm.<\/li>\n<\/ul>\n
BiPAP th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00ec \u0111i\u1ec1u n\u00e0y cung c\u1ea5p cho b\u1ec7nh nh\u00e2n m\u1ed9t ch\u00fat h\u1ed7 tr\u1ee3 c\u01a1 h\u1ecdc, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n s\u1ef1 tho\u1ea3i m\u00e1i (b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y m\u00e1y h\u1ed7 tr\u1ee3 h\u1ecd).\u00a0Tuy nhi\u00ean, BiPAP ho\u1eb7c CPAP \u0111\u1ec1u c\u00f3 hi\u1ec7u qu\u1ea3 nh\u01b0 nhau.<\/p>\n
C\u00e1c chi ti\u1ebft (nuts and bolts)<\/h3>\n
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CPAP: B\u1eaft \u0111\u1ea7u \u1edf \u00e1p l\u1ef1c th\u1ea5p (v\u00ed d\u1ee5: 5-8 cm), chu\u1ea9n \u0111\u1ed9 nhanh ch\u00f3ng l\u00ean \u00e1p l\u1ef1c t\u1ed1i \u0111a ~ 15-18 cm khi dung n\u1ea1p \u0111\u01b0\u1ee3c.<\/li>\n
BiPAP: B\u1eaft \u0111\u1ea7u \u1edf \u00e1p l\u1ef1c th\u1ea5p (v\u00ed d\u1ee5: 12 cm \/ 6 cm).\u00a0Chu\u1ea9n \u0111\u1ed9 l\u00ean nhanh ch\u00f3ng khi dung n\u1ea1p \u0111\u01b0\u1ee3c, v\u1edbi m\u1ee5c ti\u00eau t\u0103ng\u00a0\u00e1p l\u1ef1c\u00a0th\u1edf ra(v\u00ed d\u1ee5: chu\u1ea9n \u0111\u1ed9 l\u00ean \u0111\u1ebfn ~ 18 cm \/ 15 cm).<\/li>\n
\u00c1p l\u1ef1c t\u1ed1i \u0111a an to\u00e0n kh\u00f4ng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c, nh\u01b0ng \u00e1p l\u1ef1c tr\u00ean ~ 20 cm c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 b\u01a1m v\u00e0o d\u1ea1 d\u00e0y.\u00a0(\u00a0 24317204<\/a>)<\/li>\n<\/ul>\n
\u0110\u1ea3m b\u1ea3o t\u1ed1i \u01b0u h\u00f3a CPAP ho\u1eb7c BiPAP<\/h3>\n
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CPAP ho\u1eb7c BiPAP l\u00e0\u00a0li\u1ec7u ph\u00e1p d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng quan tr\u1ecdng nh\u1ea5t \u0111\u1ed1i v\u1edbi SCAPE – v\u00ec v\u1eady n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u v\u00e0 t\u1ed1i \u01b0u h\u00f3a ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00e0y.<\/li>\n
\u00c1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf cao h\u01a1n s\u1ebd gi\u1ea3m ti\u1ec1n t\u1ea3i v\u00e0 h\u1eadu t\u1ea3i hi\u1ec7u qu\u1ea3 h\u01a1n\u00a0theo ki\u1ec3u ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u l\u01b0\u1ee3ng.<\/li>\n
\u00c1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf th\u01b0\u1eddng ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh nhanh ch\u00f3ng, \u0111\u1ed3ng th\u1eddi theo d\u00f5i s\u1ef1 tho\u1ea3i m\u00e1i v\u00e0 huy\u1ebft \u0111\u1ed9ng c\u1ee7a b\u1ec7nh nh\u00e2n (\u00e1p l\u1ef1c cao h\u01a1n c\u00f3 th\u1ec3 g\u00e2y t\u1ee5t huy\u1ebft \u00e1p – \u0111\u00e2y th\u01b0\u1eddng l\u00e0 m\u1ed9t hi\u1ec7u \u1ee9ng \u0111\u00e1ng hoan ngh\u00eanh-wellcome effect).<\/li>\n
C\u00f3 l\u1ebd c\u1ea1m b\u1eaby ph\u1ed5 bi\u1ebfn nh\u1ea5t trong qu\u1ea3n l\u00fd SCAPE l\u00e0 th\u1ea5t b\u1ea1i trong vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh c\u00e0i \u0111\u1eb7t CPAP ho\u1eb7c BiPAP.\u00a0\u0110i\u1ec1u ch\u1ec9nh t\u0103ng \u00e1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf s\u1ebd l\u00e0m gi\u1ea3m ngay l\u1eadp t\u1ee9c ti\u1ec1n t\u1ea3i v\u00e0 h\u1eadu t\u1ea3i, c\u00f3 th\u1ec3 nhanh h\u01a1n v\u00e0 hi\u1ec7u qu\u1ea3 h\u01a1n b\u1ea5t k\u1ef3 lo\u1ea1i thu\u1ed1c n\u00e0o.<\/li>\n<\/ul>\n
N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ch\u1ecbu \u0111\u1ef1ng \u0111\u01b0\u1ee3c m\u1eb7t n\u1ea1 th\u00f4ng th\u01b0\u1eddng<\/h3>\n
(1) C\u00e1c k\u1ef9 thu\u1eadt c\u01a1 b\u1ea3n:<\/p>\n
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B\u1eaft \u0111\u1ea7u b\u1eb1ng c\u00e1ch gi\u1eef m\u1eb7t n\u1ea1 nh\u1eb9 nh\u00e0ng v\u00e0o m\u1eb7t b\u1ec7nh nh\u00e2n.<\/li>\n
B\u1eaft \u0111\u1ea7u v\u1edbi \u00e1p l\u1ef1c th\u1ea5p h\u01a1n, sau \u0111\u00f3 t\u0103ng \u00e1p l\u1ef1c l\u00ean khi b\u1ec7nh nh\u00e2n th\u00edch nghi v\u1edbi n\u00f3.<\/li>\n<\/ul>\n
(2) Thu\u1ed1c men:<\/p>\n
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Fentanyl c\u00f3 th\u1ec3 l\u00e0 l\u00fd t\u01b0\u1edfng \u1edf \u0111\u00e2y \u0111\u1ec3 gi\u1ea3m lo l\u1eafng v\u00e0 gi\u1ea3m c\u00f4ng th\u1edf (th\u00eam v\u1ec1 \u0111i\u1ec1u n\u00e0y\u00a0b\u00ean d\u01b0\u1edbi<\/a>\u00a0).\u00a0B\u1ec7nh nh\u00e2n th\u01b0\u1eddng kh\u00f3 dung n\u1ea1p mask v\u00ec h\u1ecd r\u1ea5t \u0111\u00f3i kh\u00ed, d\u1eabn \u0111\u1ebfn\u00a0\u0111\u00f3i d\u00f2ng-flow starvation (b\u1ec7nh nh\u00e2n mu\u1ed1n th\u1edf nhanh h\u01a1n l\u01b0\u1ee3ng kh\u00ed c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c cung c\u1ea5p t\u1eeb m\u00e1y CPAP \/ BiPAP).\u00a0Fentanyl x\u1eed l\u00fd tr\u1ef1c ti\u1ebfp c\u01a1n \u0111\u00f3i kh\u00f4ng kh\u00ed ti\u1ec1m \u1ea9n v\u00e0 lo\u1ea1i b\u1ecf v\u1ea5n \u0111\u1ec1 n\u00e0y.\u00a0\u0110\u1eebng lo l\u1eafng v\u1ec1 vi\u1ec7c g\u00e2y \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p – nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y th\u01b0\u1eddng c\u00f3\u00a0trung t\u00e2m\u00a0h\u00f4 h\u1ea5p ho\u1ea1t \u0111\u1ed9ng\u00a0qu\u00e1 m\u1ee9c\u00a0v\u1edbi nh\u1ecbp th\u1edf r\u1ea5t nhanh.<\/li>\n
Haloperidol IV ho\u1eb7c droperidol IV c\u0169ng c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn h\u1ee3p l\u00fd \u1edf \u0111\u00e2y.<\/li>\n
Thu\u1ed1c benzodiazepine IV c\u00f3 t\u00e1c d\u1ee5ng \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, nh\u01b0ng th\u01b0\u1eddng g\u00e2y l\u00fa l\u1eabn v\u00e0 \u1ee9c ch\u1ebf \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00e1c.\u00a0Ch\u00fang c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng benzodiazepine m\u1ea1n t\u00ednh, nh\u1eefng ng\u01b0\u1eddi \u0111\u00e3 \u0111\u01b0\u1ee3c bi\u1ebft l\u00e0 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi ch\u00fang.<\/li>\n<\/ul>\n
(3) C\u00e1c thi\u1ebft b\u1ecb kh\u00e1c:<\/p>\n
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M\u0169 \u0111\u1ed9i \u0111\u1ea7u (helmet) ho\u1eb7c m\u0169i (nasal) \u0111\u1ec1u c\u00f3 kh\u1ea3 n\u0103ng hi\u1ec7u qu\u1ea3.\u00a0M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 dung n\u1ea1p nh\u1eefng thi\u1ebft b\u1ecb n\u00e0y t\u1ed1t h\u01a1n so v\u1edbi m\u1eb7t n\u1ea1 m\u0169i mi\u1ec7ng th\u00f4ng th\u01b0\u1eddng.\u00a0C\u1ea3 hai thi\u1ebft b\u1ecb n\u00e0y c\u00f3 th\u1ec3 an to\u00e0n h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 b\u1ecb n\u00f4n m\u1eeda v\u00e0 sau khi h\u00fat d\u1ecbch.<\/li>\n<\/ul>\n
Nitroglycerine<\/h2>\n
\u0110i\u1ec1u c\u1ea7n thi\u1ebft l\u00e0 ph\u1ea3i gi\u1ea3m nhanh huy\u1ebft \u00e1p, c\u00f3 th\u1ec3 nh\u1eafm m\u1ee5c ti\u00eau huy\u1ebft \u00e1p t\u00e2m thu <140 mm (nh\u01b0 \u0111\u00e3 tr\u00ecnh b\u00e0y th\u00eam\u00a0 \u1edf tr\u00ean<\/a>\u00a0).\u00a0Nitroglycerine l\u00e0 bi\u1ec7n ph\u00e1p can thi\u1ec7p quan tr\u1ecdng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111i\u1ec1u n\u00e0y.<\/p>\n
M\u1ed9t s\u1ed1 \u0111i\u1ec3m ch\u00ednh v\u1ec1 nitroglycerine trong SCAPE<\/h3>\n
Li\u1ec1u nitroglycerine c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 gi\u00e3n m\u1ea1ch \u0111\u1ed9ng m\u1ea1ch trong SCAPE l\u1edbn h\u01a1n m\u1ed9t b\u1eadc so v\u1edbi li\u1ec1u th\u00f4ng th\u01b0\u1eddng c\u1ee7a nitroglycerine c\u1ea7n thi\u1ebft \u0111\u1ec3 ki\u1ec3m so\u00e1t c\u01a1n \u0111au th\u1eaft ng\u1ef1c.\u00a0\u0110i\u1ec1u n\u00e0y l\u00e0 do li\u1ec1u nitroglycerine cao h\u01a1n \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1\u00a0gi\u00e3n\u00a0m\u1ea1ch c\u1ee7a \u0111\u1ed9ng m\u1ea1ch (trong khi li\u1ec1u th\u1ea5p h\u01a1n l\u00e0 \u0111\u1ee7 \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1\u00a0gi\u00e3n t\u0129nh m\u1ea1ch\u00a0).<\/p>\n
Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9 nh\u1ea1y\u00a0r\u1ea5t kh\u00e1c nhau v\u1edbi nitroglycerine, \u0111i\u1ec1u n\u00e0y nh\u1ea5n m\u1ea1nh t\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u t\u00edch c\u1ef1c theo kinh nghi\u1ec7m.\u00a0(\u00a0 33358327<\/a>)<\/p>\n
B\u01b0\u1edbc # 1) li\u1ec1u n\u1ea1p nitroglycerine<\/h3>\n
B\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u n\u1ea1p ban \u0111\u1ea7u c\u1ee7a nitroglycerine IV l\u00e0 ~ 1.000-2.000 microgam. (\u00a0 29887195<\/a>,\u00a0 31327485<\/a> ). C\u00f3 th\u1ec3 cho theo m\u1ed9t trong hai c\u00e1ch:<\/p>\n
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(a) \u0110\u1ea9y m\u1ed9t li\u1ec1u l\u01b0\u1ee3ng 1.000-2.000 mcg nitroglycerine trong ~ 2 ph\u00fat.<\/li>\n
(b) Truy\u1ec1n nitroglycerine 400-800 mcg\/ph\u00fat trong 2,5 ph\u00fat.<\/li>\n<\/ul>\n
C\u1ea3 hai c\u00e1ch ti\u1ebfp c\u1eadn \u0111\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau, v\u1edbi s\u1ef1 l\u1ef1a ch\u1ecdn t\u00f9y thu\u1ed9c v\u00e0o thi\u1ebft b\u1ecb s\u1eb5n c\u00f3.<\/p>\n
Nguy c\u01a1 ch\u00ednh c\u1ee7a bolus nitroglycerine l\u00e0 h\u1ea1 huy\u1ebft \u00e1p.\u00a0Tuy nhi\u00ean, \u0111i\u1ec1u n\u00e0y r\u1ea5t kh\u00f3 x\u1ea3y ra n\u1ebfu ch\u1ea9n \u0111o\u00e1n SCAPE \u0111\u01b0\u1ee3c \u0111\u1ea3m b\u1ea3o (v\u00ec nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y b\u1ecb co m\u1ea1ch r\u1ea5t n\u1eb7ng).\u00a0M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y nitroglycerine bolus l\u00e0 an to\u00e0n trong b\u1ed1i c\u1ea3nh SCAPE.\u00a0Th\u1ec9nh tho\u1ea3ng nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb SCAPE c\u00f9ng v\u1edbi\u00a0gi\u1ea3mth\u1ec3\u00a0t\u00edch tu\u1ea7n ho\u00e0n\u00a0c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n h\u1ea1 huy\u1ebft \u00e1p th\u01b0\u1eddng \u0111\u00e1p \u1ee9ng v\u1edbi vi\u1ec7c theo d\u00f5i ho\u1eb7c s\u1eed d\u1ee5ng m\u1ed9t l\u01b0\u1ee3ng\u00a0 d\u1ecbch tinh th\u1ec3 – v\u00ec n\u1ed3ng \u0111\u1ed9 nitroglycerine s\u1ebd gi\u1ea3m t\u1ef1 nhi\u00ean trong v\u00f2ng\u00a0v\u00e0i ph\u00fat\u00a0.\u00a0(\u00a0 34215472<\/a>\u00a0)<\/p>\n
Ti\u00eam t\u0129nh m\u1ea1ch nitroglycerine \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 an to\u00e0n, ngay c\u1ea3 khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng b\u1edfi nh\u00e2n vi\u00ean c\u1ea5p c\u1ee9u t\u1ea1i hi\u1ec7n tr\u01b0\u1eddng.\u00a0(\u00a0 33023684<\/a>\u00a0,\u00a0 31900011<\/a>\u00a0)\u00a0\u00a0Do \u0111\u00f3, c\u00e1c b\u00e1c s\u0129 h\u1ed3i s\u1ee9c c\u0169ng n\u00ean c\u1ea3m th\u1ea5y kh\u00e1 tho\u1ea3i m\u00e1i v\u1edbi \u0111i\u1ec1u n\u00e0y.<\/p>\n
B\u01b0\u1edbc # 2) duy tr\u00ec nitroglycerine truy\u1ec1n<\/h3>\n
C\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u truy\u1ec1n nitroglycerine v\u1edbi t\u1ed1c \u0111\u1ed9 ~ 100-300 mcg \/ ph\u00fat (t\u00f9y thu\u1ed9c v\u00e0o huy\u1ebft \u00e1p ban \u0111\u1ea7u v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng).\u00a0(\u00a0 34215472<\/a>)\u00a0C\u1ea7n c\u00f3 m\u1ed9t li\u1ec1u nitroglycerine cao \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 gi\u00e3n m\u1ea1ch c\u1ee7a \u0111\u1ed9ng m\u1ea1ch, c\u00f3 th\u1ec3 \u00edt nh\u1ea5t l\u00e0 ~ 150 mcg \/ ph\u00fat.\u00a0(\u00a0 14715359<\/a>\u00a0) D\u1ef1a tr\u00ean v\u00f2ng xo\u00e1y sinh l\u00fd b\u1ec7nh lu\u1ea9n qu\u1ea9n c\u1ee7a SCAPE, t\u1ed1t h\u01a1n l\u00e0 n\u00ean b\u1eaft \u0111\u1ea7u v\u1edbi\u00a0li\u1ec1u\u00a0cao\u00a0, ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p k\u1ecbp th\u1eddi v\u00e0 sau \u0111\u00f3 gi\u1ea3m xu\u1ed1ng.<\/p>\n
N\u1ebfu huy\u1ebft \u00e1p kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t k\u1ecbp th\u1eddi, t\u0103ng li\u1ec1u nitroglycerine\u00a0t\u00edch c\u1ef1c.\u00a0Li\u1ec1u r\u1ea5t cao (v\u00ed d\u1ee5, 800 mcg \/ ph\u00fat) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u trong m\u1ed9t th\u1eddi gian gi\u1edbi h\u1ea1n, \u0111\u1ec3\u00a0ph\u00e1 v\u1ee1\u00a0v\u00f2ng xo\u00e1y t\u0103ng huy\u1ebft \u00e1p ti\u1ebfn tri\u1ec3n.\u00a0(\u00a0 32278569<\/a>\u00a0)<\/p>\n
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Vi\u1ec7c bolus nitroglycerine l\u1eb7p l\u1ea1i l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft, v\u00ec truy\u1ec1n li\u1ec1u cao s\u1ebd cung c\u1ea5p c\u00f9ng m\u1ed9t l\u01b0\u1ee3ng (v\u00ed d\u1ee5: 800 mcg\/ph\u00fat trong 5 ph\u00fat t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi 2.500 mcg bolus m\u1ed7i 5 ph\u00fat).<\/li>\n<\/ul>\n
N\u1ebfu t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb v\u1edbi 800 mcg \/ ph\u00fat nitroglycerine, th\u00ec:<\/p>\n
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\u0110\u1ea3m b\u1ea3o \u00e1p l\u1ef1c CPAP \/ BiPAP \u0111\u01b0\u1ee3c t\u1ed1i \u0111a h\u00f3a.<\/li>\n
C\u00e2n nh\u1eafc vi\u1ec7c b\u1ed5 sung nicardipine, clevidipine, IV enalaprilat, captopril v\u00e0 \/ ho\u1eb7c fentanyl.\u00a0(Th\u00eam v\u1ec1 \u0111i\u1ec1u n\u00e0y\u00a0 \u1edf tr\u00ean<\/a>.)<\/li>\n<\/ul>\n
B\u01b0\u1edbc # 3) cai nitroglycerine khi SCAPE ch\u1ea5m d\u1ee9t<\/h3>\n
Nh\u00ecn chung, SCAPE s\u1ebd b\u1eaft \u0111\u1ea7u \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft\u00a0nhanh ch\u00f3ng(trong v\u00f2ng v\u00e0i ph\u00fat \u0111\u1ebfn v\u00e0i gi\u1edd), l\u00e0m cho huy\u1ebft \u00e1p\u00a0gi\u1ea3m.\u00a0Ngay khi c\u01a1n b\u00e3o b\u1eaft \u0111\u1ea7u, n\u00f3 l\u1eb7ng l\u1ebd gi\u1ea3m b\u1edbt.<\/p>\n
Nitroglycerine th\u01b0\u1eddng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chu\u1ea9n \u0111\u1ed9 nhanh ch\u00f3ng khi SCAPE \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft.\u00a0Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, vi\u1ec7c ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p li\u00ean t\u1ee5c c\u00f3 th\u1ec3 \u0111\u00f2i h\u1ecfi b\u1ed5 sung thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng u\u1ed1ng (v\u00ed d\u1ee5: thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n) – nh\u01b0ng trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, \u0111i\u1ec1u n\u00e0y kh\u00f4ng c\u1ea7n thi\u1ebft.\u00a0(Xem th\u00eam v\u1ec1 thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng u\u1ed1ng\u00a0 b\u00ean d\u01b0\u1edbi<\/a>.)<\/p>\n
Theo d\u00f5i huy\u1ebft \u00e1p th\u1eadt c\u1ea9n th\u1eadn v\u00e0 gi\u1ea3m li\u1ec1u nitroglycerine truy\u1ec1n cho ph\u00f9 h\u1ee3p, \u0111\u1ec3 tr\u00e1nh t\u1ee5t huy\u1ebft \u00e1p.<\/p>\n
Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi nitroglycerine?<\/h3>\n
Nitroglycerine ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1edbi d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf men phosphodiesterase type-5 (v\u00ed d\u1ee5, sildenafil, tadalafil, vardenafil).\u00a0Nicardipine ho\u1eb7c clevidipine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t cho nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n
H\u1eb9p eo \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 kh\u00f4ng ph\u1ea3i l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi nitroglycerine trong b\u1ed1i c\u1ea3nh SCAPE.\u00a0Tuy nhi\u00ean, c\u1ea7n th\u1eadn tr\u1ecdng h\u01a1n (c\u00f3 l\u1ebd li\u1ec1u th\u1ea5p h\u01a1n m\u1ed9t ch\u00fat v\u00e0 chu\u1ea9n \u0111\u1ed9 li\u1ec1u ch\u1eadm h\u01a1n b\u00ecnh th\u01b0\u1eddng).\u00a0(\u00a0 26002298<\/a>)<\/p>\n
Nitroglycerine ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i<\/h3>\n
C\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng n\u1ebfu m\u1ed9t b\u1ec7nh nh\u00e2n b\u1ecb SCAPE \u1edf m\u1ed9t \u0111\u1ecba \u0111i\u1ec3m\u00a0kh\u00f4ng th\u1ec3cung c\u1ea5p nitroglycerine IV.<\/p>\n
M\u1ee5c ti\u00eau c\u1ee7a nitroglycerine ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i\u00a0ch\u1ec9 l\u00e0\u00a0l\u00e0m c\u1ea7u n\u1ed1i cho b\u1ec7nh nh\u00e2n cho \u0111\u1ebfn khi h\u1ecd c\u00f3 th\u1ec3 nh\u1eadn \u0111\u01b0\u1ee3c nitroglycerine IV – kh\u00f4ng ph\u1ea3i l\u00e0 thu\u1ed1c thay th\u1ebf nitroglycerine IV.\u00a0B\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u01b0\u1ee3c v\u1eadn chuy\u1ec3n ngay l\u1eadp t\u1ee9c \u0111\u1ebfn m\u1ed9t \u0111\u1ecba \u0111i\u1ec3m c\u00f3 kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb d\u1ee9t \u0111i\u1ec3m (IV nitroglycerine v\u00e0 th\u00f4ng kh\u00ed kh\u00f4ng x\u00e2m l\u1ea5n).<\/p>\n
Li\u1ec1u t\u1ed1i \u01b0u ch\u01b0a r\u00f5 r\u00e0ng, nh\u01b0ng 3-5 vi\u00ean n\u00e9n 400 mcg ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i trong v\u00f2ng 5 ph\u00fat c\u00f3 th\u1ec3 l\u00e0 h\u1ee3p l\u00fd.\u00a0(L\u01b0u \u00fd r\u1eb1ng sinh kh\u1ea3 d\u1ee5ng c\u1ee7a nitroglycerine ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i ch\u1ec9 l\u00e0 ~ 40%.)<\/p>\n
Opioid<\/h2>\n
T\u1ed5ng quan<\/h3>\n
Opioid mang l\u1ea1i nhi\u1ec1u l\u1ee3i \u00edch v\u1ec1 m\u1eb7t l\u00fd thuy\u1ebft cho b\u1ec7nh nh\u00e2n SCAPE – bao g\u1ed3m gi\u00e3n t\u0129nh m\u1ea1ch, h\u1ee7y giao c\u1ea3m v\u00e0 gi\u1ea3i lo \u00e2u.\u00a0(\u00a0 28839968<\/a>)<\/p>\n
C\u00e1cnghi\u00ean c\u1ee9u\u00a0h\u1ed3i\u00a0c\u1ee9u \u0111\u00e3 cho th\u1ea5y m\u1ed1i t\u01b0\u01a1ng quan gi\u1eefa vi\u1ec7c s\u1eed d\u1ee5ng\u00a0morphin\u00a0v\u1edbi k\u1ebft c\u1ee5c x\u1ea5u h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ph\u00f9 ph\u1ed5i.\u00a0\u0110i\u1ec1u n\u00e0y kh\u00f4ng c\u00f3 g\u00ec \u0111\u00e1ng ng\u1ea1c nhi\u00ean.\u00a0B\u1ec7nh nh\u00e2n n\u1eb7ng h\u01a1n d\u1ec5 b\u1ecb \u0111\u00f3i kh\u00ed h\u01a1n, x\u00fai gi\u1ee5c vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng morphin.\u00a0C\u0169ng c\u00f3 th\u1ec3 hi\u1ec3u r\u1eb1ng morphin c\u00f3 th\u1ec3 che d\u1ea5u c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a ph\u00f9 ph\u1ed5i, khi\u1ebfn c\u00e1c b\u00e1c s\u0129 \u00edt t\u00edch c\u1ef1c h\u01a1n v\u1edbi c\u00e1c li\u1ec7u ph\u00e1p kh\u00e1c (v\u00ed d\u1ee5, b\u1ec7nh nh\u00e2n tr\u00f4ng kh\u00f4ng \u0111\u1ee7 n\u1eb7ng \u0111\u1ebfn m\u1ee9c c\u1ea7n CPAP).<\/p>\n
Vai tr\u00f2 c\u1ee7a opioid trong SCAPE v\u1eabn c\u00f2n nhi\u1ec1u tranh c\u00e3i.\u00a0Tuy nhi\u00ean, opioid c\u00f3 th\u1ec3 h\u1eefu \u00edch \u1edf m\u1ed9t\u00a0nh\u00f3m b\u1ec7nh nh\u00e2n\u00a0\u0111\u01b0\u1ee3c ch\u1ecdnl\u1ecdc, khi \u0111\u01b0\u1ee3c t\u00edch h\u1ee3p v\u00e0o m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u00f3 t\u1ed5 ch\u1ee9c.<\/p>\n
Fentanylc\u00f3 l\u1ebd l\u00e0 thu\u1ed1c t\u1ed1t nh\u1ea5t \u1edf \u0111\u00e2y, v\u00ec nh\u1eefng l\u00fd do sau:<\/p>\n
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Fentanyl c\u00f3 t\u00e1c d\u1ee5ng kh\u1edfi ph\u00e1t nhanh, cho ph\u00e9p chu\u1ea9n \u0111\u1ed9 ch\u00ednh x\u00e1c.<\/li>\n
Fentanyl kh\u00f4ng g\u00e2y gi\u1ea3i ph\u00f3ng histamine, l\u00e0m cho n\u00f3 \u00edt c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y bu\u1ed3n n\u00f4n \/ n\u00f4n.<\/li>\n<\/ul>\n
Nh\u1eefng ch\u1ec9 \u0111\u1ecbnh ti\u1ec1m n\u0103ng cho fentanyl?<\/h3>\n
(1) Kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng dung n\u1ea1p m\u1eb7t n\u1ea1 CPAP \/ BiPAP.\u00a0(\u00a0 28507398<\/a>)<\/p>\n
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T\u00ecnh tr\u1ea1ng \u0111\u00f3i kh\u00ed r\u00f5 r\u1ec7t c\u00f3 th\u1ec3 khi\u1ebfn b\u1ec7nh nh\u00e2n kh\u00f3 dung n\u1ea1p \u0111\u01b0\u1ee3c th\u00f4ng kh\u00ed kh\u00f4ng x\u00e2m l\u1ea5n.<\/li>\n
Fentanyl tr\u1ef1c ti\u1ebfp l\u00e0m gi\u1ea3m c\u1ea3m gi\u00e1c \u0111\u00f3i kh\u00ed, v\u00ec v\u1eady \u0111\u00e2y l\u00e0 m\u1ed9t c\u00e1ch ti\u1ebfp c\u1eadn sinh l\u00fd tr\u1ef1c ti\u1ebfp v\u1edbi v\u1ea5n \u0111\u1ec1 c\u01a1 b\u1ea3n.<\/li>\n<\/ul>\n
(2) Kh\u00f3 th\u1edf \/ lo l\u1eafng t\u1ed9t \u0111\u1ed9?<\/p>\n
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\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf n\u1eb7ng, fentanyl li\u1ec1u th\u1ea5p c\u00f3 th\u1ec3 l\u00e0 h\u1ee3p l\u00fd \u0111\u1ec3 t\u1ea1o s\u1ef1 tho\u1ea3i m\u00e1i v\u00e0 gi\u1ea3m ho\u1ea1t h\u00f3a giao c\u1ea3m do lo l\u1eafng.<\/li>\n<\/ul>\n
Fentanyl kh\u00f4ng bao gi\u1edd \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng\u00a0m\u1ed9t m\u00ecnh \u0111\u1ec3 ki\u1ec3m so\u00e1t c\u01a1n \u0111\u00f3i kh\u00ed, m\u00e0 ch\u1ec9\u00a0\u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng\u00a0nh\u01b0 m\u1ed9t\u00a0t\u00e1c nh\u00e2n\u00a0b\u1ed5 tr\u1ee3\u00a0k\u1ebft h\u1ee3p v\u1edbi CPAP \/ BiPAP v\u00e0 nitrat.<\/p>\n
SCAPE n\u00f3i chung s\u1ebd b\u1eaft \u0111\u1ea7u c\u1ea3i thi\u1ec7n nhanh ch\u00f3ng, v\u00ec v\u1eady fentanyl\u00a0ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh l\u00fac ban \u0111\u1ea7u.\u00a0N\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u00f3i kh\u00ed dai d\u1eb3ng trong v\u00e0i gi\u1edd, \u0111i\u1ec1u n\u00e0y g\u1ee3i \u00fd m\u1ed9t ch\u1ea9n \u0111o\u00e1n thay th\u1ebf – \u0111\u00e1nh gi\u00e1 l\u1ea1i nguy\u00ean nh\u00e2n g\u00e2y kh\u00f3 th\u1edf kh\u00e1c.<\/p>\n
Thu\u1ed1c gi\u00e3n m\u1ea1ch u\u1ed1ng<\/h2>\n
Th\u1eadn tr\u1ecdng v\u1edbi thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng u\u1ed1ng<\/h3>\n
D\u1ea5u hi\u1ec7u ti\u00eau chu\u1ea9n c\u1ee7a SCAPE l\u00e0 huy\u1ebft \u00e1p kh\u00f4ng \u1ed5n \u0111\u1ecbnh.\u00a0Ban \u0111\u1ea7u b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p m\u1ed9t c\u00e1ch n\u1eb7ng n\u1ec1, nh\u01b0ng v\u1edbi s\u1ef1 ch\u1ea5m d\u1ee9t c\u1ee7a SCAPE, h\u1ecd th\u01b0\u1eddng chuy\u1ec3n sang tr\u1ea1ng th\u00e1i huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng (m\u00e0 kh\u00f4ng c\u1ea7n d\u00f9ng b\u1ea5t k\u1ef3 lo\u1ea1i thu\u1ed1c n\u00e0o).<\/p>\n
H\u00e3y c\u1ea9n th\u1eadn khi b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i trong\u00a0giai \u0111o\u1ea1n\u00a0c\u1ea5p t\u00ednh c\u1ee7a SCAPE, v\u00ec \u0111i\u1ec1u n\u00e0y cu\u1ed1i c\u00f9ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn\u00a0t\u1ee5t huy\u1ebft \u00e1p\u00a0d\u1ed9i l\u1ea1i (rebound)\u00a0sau khi SCAPE \u0111\u00e3 h\u1ebft.<\/p>\n
Khi n\u00e0o s\u1eed d\u1ee5ng thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng u\u1ed1ng<\/h3>\n
Th\u1eddi \u0111i\u1ec3m t\u1ed1t nh\u1ea5t \u0111\u1ec3 b\u1eaft \u0111\u1ea7u thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng u\u1ed1ng l\u00e0 n\u1ebfu t\u00ecnh hu\u1ed1ng sau x\u1ea3y ra – m\u00e0 th\u1ef1c t\u1ebf l\u00e0\u00a0kh\u00f4ng th\u01b0\u1eddng g\u1eb7p:<\/p>\n
\n
(1) Ph\u00f9 ph\u1ed5i ch\u1ea5m d\u1ee9t sau khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng nitroglycerine IV truy\u1ec1n (v\u00ed d\u1ee5, h\u1ebft t\u00ecnh tr\u1ea1ng kh\u00f3 th\u1edf v\u00e0 gi\u1ea3m oxy m\u00e1u).<\/li>\n
(2)\u00a0\u0110\u00f2i h\u1ecfi nitroglycerine IV truy\u1ec1n dai d\u1eb3ng \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p.<\/li>\n
(3) Nhu c\u1ea7u nitroglycerine t\u01b0\u01a1ng \u0111\u1ed1i\u00a0\u1ed5n \u0111\u1ecbnh trong v\u00e0i gi\u1edd.<\/li>\n<\/ul>\n
Trong t\u00ecnh hu\u1ed1ng n\u00e0y, thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 cai nitroglycerine IV.\u00a0S\u1eed d\u1ee5ng thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng u\u1ed1ng m\u1ea1n t\u00ednh c\u0169ng c\u00f3 th\u1ec3 gi\u00fap ng\u0103n ng\u1eeba s\u1ef1 t\u00e1i ph\u00e1t c\u1ee7a c\u00e1c \u0111\u1ee3t SCAPE.<\/p>\n
Trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p SCAPE, s\u1ef1 c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng s\u1ebd cho ph\u00e9p cai IV nitroglycerine\u00a0m\u00e0 kh\u00f4ng c\u1ea7ns\u1eed d\u1ee5ng\u00a0b\u1ea5t k\u1ef3\u00a0thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p \u0111\u01b0\u1eddng u\u1ed1ng\u00a0n\u00e0o\u00a0.<\/p>\n
Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n & ch\u1eb9n th\u1ee5 th\u1ec3<\/h3>\n
Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin (ARB) c\u00f3 l\u1ebd l\u00e0 thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p t\u1ed1t nh\u1ea5t cho nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y, n\u1ebfu ch\u1ee9c n\u0103ng th\u1eadn cho ph\u00e9p.<\/p>\n
Captopril \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u01a1n v\u00ec n\u00f3 c\u00f3 t\u00e1c d\u1ee5ng nhanh.\u00a0\u0110i\u1ec1u n\u00e0y cho ph\u00e9p \u0111\u00e1nh gi\u00e1 nhanh c\u00e1c hi\u1ec7u qu\u1ea3 c\u1ee7a n\u00f3 v\u00e0 chu\u1ea9n \u0111\u1ed9 \u0111\u01b0\u1eddng u\u1ed1ng nhanh ch\u00f3ng.\u00a0V\u00ed d\u1ee5, m\u1ed9t li\u1ec1u 12,5-25 mg c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh v\u00e0 c\u00f3 th\u1ec3\u00a0l\u1eb7p l\u1ea1i sau\u00a0~ 2 gi\u1edd n\u1ebfu hi\u1ec7u qu\u1ea3 kh\u00f4ng \u0111\u1ee7.<\/p>\n
H\u1ea1n ch\u1ebf ch\u00ednh c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 ARB l\u00e0 kh\u1ea3 n\u0103ng g\u00e2y \u0111\u1ed9c cho th\u1eadn.\u00a0Nh\u1eefng thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 kh\u00f4ng l\u00fd t\u01b0\u1edfng cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p t\u00ednh, ho\u1eb7c nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u b\u1ec7nh \u0111\u1ed3ng m\u1eafc \u0111ang ho\u1ea1t \u0111\u1ed9ng.<\/p>\n
Hydralazine \/ isosorbide dinitrate u\u1ed1ng<\/h3>\n
S\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a hydralazine v\u1edbi isosorbide dinitrate \u0111\u01b0\u1eddng u\u1ed1ng t\u1ea1o ra t\u00e1c d\u1ee5ng huy\u1ebft \u0111\u1ed9ng t\u01b0\u01a1ng t\u1ef1 so v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n m\u00e0 kh\u00f4ng c\u00f3 nguy c\u01a1 g\u00e2y \u0111\u1ed9c cho th\u1eadn.<\/p>\n
Li\u1ec1u kh\u1edfi \u0111\u1ea7u th\u00f4ng th\u01b0\u1eddng l\u00e0 isosorbide dinitrate (ISORDIL) 20 mg u\u1ed1ng m\u1ed7i 8 gi\u1edd c\u1ed9ng v\u1edbi hydralazine 37,5 mg u\u1ed1ng m\u1ed7i 8 gi\u1edd.\u00a0Li\u1ec1u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u0103ng l\u00ean \u0111\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3.<\/p>\n
S\u1ef1 k\u1ebft h\u1ee3p n\u00e0y r\u1ea5t h\u1eefu \u00edch cho s\u1ef1\u00a0\u1ed5n \u0111\u1ecbnh\u00a0c\u1ea5p t\u00ednh.\u00a0Khi b\u1ec7nh nh\u00e2n \u0111\u00e3 kh\u1ecfi \u0111\u1ee3t c\u1ea5p v\u00e0 t\u00ecnh tr\u1ea1ng th\u1ec3 t\u00edch c\u1ee7a h\u1ecd \u0111\u00e3 \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u h\u00f3a, s\u1ef1 k\u1ebft h\u1ee3p th\u01b0\u1eddng s\u1ebd \u0111\u01b0\u1ee3c chuy\u1ec3n sang m\u1ed9t lo\u1ea1i thu\u1ed1c kh\u00e1c (v\u00ed d\u1ee5: \u1ee9c ch\u1ebf men chuy\u1ec3n).<\/p>\n
Qu\u1ea3n l\u00fd th\u1ec3 t\u00edch & l\u1ee3i ti\u1ec3u<\/h2>\n
C\u00e1c kh\u00e1i ni\u1ec7m ch\u00ednh li\u00ean quan \u0111\u1ebfn qu\u1ea3n l\u00fd d\u1ecbch<\/h3>\n
L\u1ee3i ti\u1ec3u kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t can thi\u1ec7p h\u00e0ng \u0111\u1ea7u trong SCAPE.\u00a0V\u1ea5n \u0111\u1ec1 sinh l\u00fd b\u1ec7nh quan tr\u1ecdng v\u1edbi SCAPE l\u00e0 kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng ch\u1ea3y tr\u00e0n giao c\u1ea3m v\u00e0 t\u0103ng h\u1eadu t\u1ea3i.\u00a0Nhi\u1ec1u b\u1ec7nh nh\u00e2n SCAPE c\u00f3 th\u1ec3 l\u00e0 \u0111\u1eb3ng th\u1ec3 t\u00edch ho\u1eb7c th\u1eadm ch\u00ed gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n (ch\u1ec9 \u0111\u01a1n thu\u1ea7n l\u00e0 g\u1eb7p ph\u1ea3i t\u00ecnh tr\u1ea1ng\u00a0ph\u00e2n b\u1ed1 sai l\u01b0\u1ee3ng d\u1ecbch di chuy\u1ec3n v\u00e0o ph\u1ed5i).<\/p>\n
C\u00e1ch ti\u1ebfp c\u1eadn qu\u1ea3n l\u00fd d\u1ecbch trong SCAPE<\/h3>\n
C\u00e1c li\u1ec7u ph\u00e1p ban \u0111\u1ea7u l\u00e0 th\u00f4ng kh\u00ed \u00e1p l\u1ef1c d\u01b0\u01a1ng v\u00e0 ki\u1ec3m so\u00e1t h\u1eadu t\u1ea3i (th\u01b0\u1eddng l\u00e0 v\u1edbi nitroglycerine li\u1ec1u cao).\u00a0Nh\u1eefng \u0111i\u1ec1u n\u00e0y n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ngay l\u1eadp t\u1ee9c, tr\u01b0\u1edbc khi xem x\u00e9t c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u.<\/p>\n
\u0110\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng sau khi b\u1eaft \u0111\u1ea7u d\u00f9ng nitrat v\u00e0 th\u00f4ng kh\u00ed \u00e1p l\u1ef1c d\u01b0\u01a1ng (v\u00ed d\u1ee5, v\u1edbi si\u00eau \u00e2m tim).\u00a0N\u1ebfu c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u0103ng th\u1ec3 t\u00edch tu\u1ea9n ho\u00e0n, th\u00ec vi\u1ec7c lo\u1ea1i b\u1ecf th\u1ec3 t\u00edch c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i (b\u1eb1ng b\u00e0i ni\u1ec7u ho\u1eb7c l\u1ecdc m\u00e1u).\u00a0L\u1ee3i \u00edch t\u1eeb vi\u1ec7c lo\u1ea1i b\u1ecf th\u1ec3 t\u00edch \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 \u0111\u1eb7c bi\u1ec7t n\u1ebfu c\u00f3 ti\u1ec1n\u00a0s\u1eed l\u00e2m s\u00e0ng g\u1ee3i \u00fd v\u1ec1 t\u00ecnh tr\u1ea1ng qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch (v\u00ed d\u1ee5, kh\u00f4ng tu\u00e2n th\u1ee7 thu\u1ed1c l\u1ee3i ti\u1ec3u, ho\u1eb7c b\u1ecf l\u1ee1 c\u00e1c bu\u1ed5i ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o).<\/p>\n
Bi\u1ebft \u00e1p l\u1ef1c BiPAP c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 t\u00edch c\u1ef1c \u0111i\u1ec1u ch\u1ec9nh ch\u00fang.\u00a0Ch\u1ec9 kh\u1edfi \u0111\u1ed9ng BiPAP l\u00e0 kh\u00f4ng \u0111\u1ee7, \u00e1p l\u1ef1c n\u00ean \u0111\u01b0\u1ee3c t\u0103ng l\u00ean nhanh ch\u00f3ng.\u00a0BiPAP \u1edf 18cm \/ 15 cm s\u1ebd l\u00e0m \u0111\u01b0\u1ee3c nhi\u1ec1u \u0111i\u1ec1u h\u01a1n 10cm \/ 5cm.<\/p>\n
KH\u00d4NG tr\u00ec ho\u00e3n vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng BiPAP v\u00e0 nitroglycerine trong khi ch\u1edd xem li\u1ec7u l\u1ee3i ti\u1ec3u c\u00f3 hi\u1ec7u qu\u1ea3 hay kh\u00f4ng.<\/p>\n
KH\u00d4NG c\u1ed1 g\u1eafng \u0111i\u1ec1u tr\u1ecb c\u01a1n t\u0103ng huy\u1ebft \u00e1p c\u1ee7a b\u1ec7nh nh\u00e2n SCAPE b\u1eb1ng thu\u1ed1c ch\u1eb9n beta.\u00a0V\u1ea5n \u0111\u1ec1 sinh l\u00fd b\u1ec7nh l\u00e0 qu\u00e1 t\u1ea3i, m\u00e0 thu\u1ed1c ch\u1eb9n beta s\u1ebd kh\u00f4ng gi\u1ea3i quy\u1ebft \u0111\u01b0\u1ee3c.\u00a0Thu\u1ed1c ch\u1eb9n beta c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m ch\u1ee9c n\u0103ng b\u01a1m, do \u0111\u00f3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam t\u00ecnh tr\u1ea1ng ph\u00f9 ph\u1ed5i.<\/p>\n
C\u1ed1 g\u1eafng tr\u00e1nh \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n n\u1ebfu c\u00f3 th\u1ec3, v\u00ec nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y th\u01b0\u1eddng s\u1ebd c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 v\u00e0 nhanh ch\u00f3ng v\u1edbi BiPAP v\u00e0 nitroglycerine li\u1ec1u cao.\u00a0Nh\u1eefng b\u1ec7nh nh\u00e2n tr\u00f4ng c\u00f3 v\u1ebb t\u1ed3i t\u1ec7 kinh kh\u1ee7ng th\u01b0\u1eddng s\u1ebd c\u1ea3i thi\u1ec7n trong v\u00f2ng v\u00e0i ph\u00fat.<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
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29776826 Paone S, Clarkson L, Sin B, Punnapuzha S. Recognition of Sympathetic Crashing Acute Pulmonary Edema (SCAPE) and use of high-dose nitroglycerin infusion. Am J Emerg Med. 2018 Aug;36(8):1526.e5-1526.e7. doi: 10.1016\/j.ajem.2018.05.013\u00a0 [PubMed<\/a>]<\/li>\n
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29942881 Hsieh YT, Lee TY, Kao JS, Hsu HL, Chong CF. Treating acute hypertensive cardiogenic pulmonary edema with high-dose nitroglycerin. Turk J Emerg Med. 2018 Feb 2;18(1):34-36. doi: 10.1016\/j.tjem.2018.01.004\u00a0 [PubMed<\/a>]<\/li>\n
31327485 Wang K, Samai K. Role of high-dose intravenous nitrates in hypertensive acute heart failure. Am J Emerg Med. 2020 Jan;38(1):132-137. doi: 10.1016\/j.ajem.2019.06.046\u00a0 [PubMed<\/a>]<\/li>\n
31472891 Liu JX, Uppal S, Patel V. Management of Acute Hypertensive Heart Failure. Heart Fail Clin. 2019 Oct;15(4):565-574. doi: 10.1016\/j.hfc.2019.06.009\u00a0 [PubMed<\/a>]<\/li>\n
32278569 Stemple K, DeWitt KM, Porter BA, Sheeser M, Blohm E, Bisanzo M. High-dose nitroglycerin infusion for the management of sympathetic crashing acute pulmonary edema (SCAPE): A case series. Am J Emerg Med. 2021 Jun;44:262-266. doi: 10.1016\/j.ajem.2020.03.062\u00a0 [PubMed<\/a>]<\/li>\n
32298495 Killeen BM, Wolfson AB. Noninvasive Positive Pressure Ventilation for Cardiogenic Pulmonary Edema. Acad Emerg Med. 2020 Dec;27(12):1358-1359. doi: 10.1111\/acem.13986\u00a0 [PubMed<\/a>]<\/li>\n
33023684 Perlmutter MC, Cohen MW, Stratton NS, Conterato M. Prehospital Treatment of Acute Pulmonary Edema with Intravenous Bolus and Infusion Nitroglycerin. Prehosp Disaster Med. 2020 Dec;35(6):663-668. doi: 10.1017\/S1049023X20001193\u00a0 [PubMed<\/a>]<\/li>\n
33358327 Raggi JR, O’Connell TW, Singer DJ. Nicardipine: When high dose nitrates fail in treating heart failure. Am J Emerg Med. 2021 Jul;45:681.e3-681.e5. doi: 10.1016\/j.ajem.2020.12.016\u00a0 [PubMed<\/a>]<\/li>\n
33563668 Shrimal P, Sahu AK, Mathew R, Bansal A. Pickering syndrome: a rare presentation in emergency department. BMJ Case Rep. 2021 Feb 9;14(2):e239421. doi: 10.1136\/bcr-2020-239421\u00a0 [PubMed<\/a>]<\/li>\n
33611627 Harrison N, Pang P, Collins S, Levy P. Blood Pressure Reduction in Hypertensive Acute Heart Failure. Curr Hypertens Rep. 2021 Feb 20;23(2):11. doi: 10.1007\/s11906-021-01127-8\u00a0 [PubMed<\/a>]<\/li>\n
33718922 Gyory M, Abdallah S, Lagina A, Levy PD, Twiner MJ. Ultra-high dose intravenous nitroglycerin in an ESRD patient with acutely decompensated heart failure. J Am Coll Emerg Physicians Open. 2021 Mar 2;2(2):e12387. doi: 10.1002\/emp2.12387\u00a0 [PubMed<\/a>]<\/li>\n
34215472 Mathew R, Kumar A, Sahu A, Wali S, Aggarwal P. High-Dose Nitroglycerin Bolus for Sympathetic Crashing Acute Pulmonary Edema: A Prospective Observational Pilot Study. J Emerg Med. 2021 Jun 29:S0736-4679(21)00467-4. doi: 10.1016\/j.jemermed.2021.05.011\u00a0 [PubMed<\/a>]<\/li>\n<\/ol>\n
Going further:<\/p>\n
\n
EMCrit Podcast #1:\u00a0 Sympathetic crashing acute pulmonary edema<\/a><\/li>\n
When to wean the CPAP in SCAPE<\/a>(EMCrit RACC, Scott Weingart)<\/li>\n
High-dose NTG and NIV for SCAPE<\/a>(RebelEM by Salim Rezaie)<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
nhathuocluuanh.Ph\u00f9 ph\u1ed5i c\u1ea5p ch\u1edbp nho\u00e1ng (SCAPE) Josh Farkas Bi\u00ean d\u1ecbch: Ths.Bs Ph\u1ea1m Ho\u00e0ng Thi\u00ean Tham kh\u1ea3o nhanh SCAPE dx & rx checklist C\u00e1c ph\u00e1t hi\u1ec7n l\u00e2m s\u00e0ng trung t\u00e2m c\u1ee7a SCAPE Kh\u1edfi ph\u00e1t kh\u00f3 th\u1edf d\u1eef d\u1ed9i m\u1ed9t c\u00e1ch nhanh ch\u00f3ng. Gi\u1ea3m oxy m\u00e1u. T\u0103ng huy\u1ebft \u00e1p (HATT > 160 mm v\u00e0 \/ ho\u1eb7c HA […]\n","protected":false},"author":1,"featured_media":34153,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-34146","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\/34146","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=34146"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/34146\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/34153"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=34146"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=34146"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=34146"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}