![\"\"](\"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-content\/uploads\/2025\/11\/BAI-2-1110-TAC-DONG-MACH-PHOI-CAP.jpg\")
<\/figure>\n\n\n\nThuy\u00ean t\u1eafc ph\u1ed5i \u1ea3nh h\u01b0\u1edfng nghi\u00eam tr\u1ecdng \u0111\u1ebfn tu\u1ea7n ho\u00e0n v\u00e0 h\u00f4 h\u1ea5p, trong \u0111\u00f3 suy th\u1ea5t ph\u1ea3i do qu\u00e1 t\u1ea3i \u00e1p l\u1ef1c l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y t\u1eed vong \u1edf nh\u1eefng ca n\u1eb7ng. S\u1ef1 gia t\u0103ng \u0111\u1ed9t ng\u1ed9t s\u1ee9c c\u1ea3n m\u1ea1ch ph\u1ed5i khi\u1ebfn th\u1ea5t ph\u1ea3i gi\u00e3n n\u1edf, l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng co b\u00f3p theo c\u01a1 ch\u1ebf Frank-Starling.<\/p>\n\n\n\n
Nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh <\/h2>\n\n\n\n
Nguy\u00ean nh\u00e2n ch\u1ee7 y\u1ebfu c\u1ee7a t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i l\u00e0 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u (DVT) \u2013 th\u01b0\u1eddng h\u00ecnh th\u00e0nh \u1edf chi d\u01b0\u1edbi, sau \u0111\u00f3 di chuy\u1ec3n theo d\u00f2ng m\u00e1u l\u00ean \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n\n\n\n
C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea5p<\/strong><\/h3>\n\n\n\n\n- Tu\u1ed5i cao (\u0111\u1eb7c bi\u1ec7t t\u1eeb 70 tu\u1ed5i tr\u1edf l\u00ean)<\/li>\n\n\n\n
- B\u1ea5t \u0111\u1ed9ng k\u00e9o d\u00e0i: do n\u1eb1m vi\u1ec7n l\u00e2u ng\u00e0y, sau ph\u1eabu thu\u1eadt, ch\u1ea5n th\u01b0\u01a1ng n\u1eb7ng, ho\u1eb7c di chuy\u1ec3n xa (\u0111i m\u00e1y bay, \u00f4 t\u00f4 \u0111\u01b0\u1eddng d\u00e0i)<\/li>\n\n\n\n
- Ph\u1eabu thu\u1eadt l\u1edbn: \u0111\u1eb7c bi\u1ec7t \u1edf v\u00f9ng b\u1ee5ng, ch\u1eadu, ho\u1eb7c chi d\u01b0\u1edbi<\/li>\n\n\n\n
- B\u1ec7nh tim m\u1ea1ch v\u00e0 c\u00e1c b\u1ec7nh l\u00fd n\u1ed9i khoa n\u1eb7ng<\/li>\n\n\n\n
- Ung th\u01b0 ho\u1eb7c \u0111ang \u0111i\u1ec1u tr\u1ecb ung th\u01b0<\/li>\n\n\n\n
- Thai k\u1ef3, sau sinh<\/li>\n\n\n\n
- D\u00f9ng thu\u1ed1c n\u1ed9i ti\u1ebft: nh\u01b0 thu\u1ed1c tr\u00e1nh thai ho\u1eb7c hormone thay th\u1ebf<\/li>\n\n\n\n
- R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u: b\u1ea9m sinh ho\u1eb7c m\u1eafc ph\u1ea3i, t\u1eebng c\u00f3 ti\u1ec1n s\u1eed c\u1ee5c m\u00e1u \u0111\u00f4ng<\/li>\n\n\n\n
- Ch\u1ea5n th\u01b0\u01a1ng, g\u00e3y x\u01b0\u01a1ng<\/li>\n\n\n\n
- B\u00e9o ph\u00ec, h\u00fat thu\u1ed1c l\u00e1<\/li>\n<\/ul>\n\n\n\n
Bi\u1ec3u hi\u1ec7n t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i <\/h2>\n\n\n\n
Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a thuy\u00ean t\u1eafc ph\u1ed5i \u0111a d\u1ea1ng v\u00e0 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, d\u1ec5 b\u1ecf s\u00f3t. Tri\u1ec7u ch\u1ee9ng c\u1ee7a PE c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t v\u00e0 \u0111a d\u1ea1ng, t\u00f9y thu\u1ed9c v\u00e0o k\u00edch th\u01b0\u1edbc kh\u1ed1i t\u1eafc v\u00e0 t\u00ecnh tr\u1ea1ng tim ph\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n:<\/p>\n\n\n\n
\n- M\u1ed9t s\u1ed1 bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p:\n
\n- Kh\u00f3 th\u1edf \u0111\u1ed9t ng\u1ed9t (tri\u1ec7u ch\u1ee9ng ph\u1ed5 bi\u1ebfn nh\u1ea5t)<\/li>\n\n\n\n
- \u0110au ng\u1ef1c ki\u1ec3u m\u00e0ng ph\u1ed5i, t\u0103ng khi h\u00edt s\u00e2u ho\u1eb7c ho<\/li>\n\n\n\n
- Ho khan ho\u1eb7c ho ra m\u00e1u<\/li>\n\n\n\n
- Tim \u0111\u1eadp nhanh, nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u<\/li>\n\n\n\n
- H\u1ea1 huy\u1ebft \u00e1p, ch\u00f3ng m\u1eb7t, ng\u1ea5t x\u1ec9u (trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng)<\/li>\n\n\n\n
- T\u00edm t\u00e1i, \u0111\u1eb7c bi\u1ec7t \u1edf m\u00f4i v\u00e0 \u0111\u1ea7u chi<\/li>\n\n\n\n
- S\u1ed1t nh\u1eb9 ho\u1eb7c c\u1ea3m gi\u00e1c lo l\u1eafng, b\u1ed3n ch\u1ed3n kh\u00f4ng r\u00f5 l\u00fd do<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- Tri\u1ec7u ch\u1ee9ng \u00edt g\u1eb7p: ho m\u00e1u, thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i tinh th\u1ea7n (ng\u01b0\u1eddi gi\u00e0)<\/li>\n\n\n\n
- Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng: t\u1ee5t huy\u1ebft \u00e1p, nh\u1ecbp tim nhanh, cho\u00e1ng v\u00e1ng\/ng\u1ea5t, th\u1eadm ch\u00ed ng\u01b0ng tim<\/li>\n<\/ul>\n\n\n\n
Ch\u1ea9n \u0111o\u00e1n<\/h2>\n\n\n\n
Ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i: kh\u00f3, kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/p>\n\n\n\n
\n- D\u1ef1a tr\u00ean thang \u0111i\u1ec3m nguy c\u01a1 (Well, Geneva)<\/li>\n\n\n\n
- T\u0103ng D-dimer m\u00e1u<\/li>\n\n\n\n
- Ch\u1ee5p MDCT, ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea3n quang<\/li>\n\n\n\n
- Si\u00eau \u00e2m Doppler tim; si\u00eau \u00e2m t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi<\/li>\n<\/ul>\n\n\n\n
\u0110i\u1ec1u tr\u1ecb t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea5p t\u00ednh <\/h2>\n\n\n\n\n- H\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng v\u00e0 h\u00f4 h\u1ea5p:\n
\n- Suy tim c\u1ea5p ph\u1ea3i dung v\u1eadn m\u1ea1ch (Dobutamine, Dopamin), c\u00f9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb t\u00e1i th\u00f4ng m\u1ea1ch b\u1eb1ng thu\u1ed1c hay th\u1ee7 thu\u1eadt.<\/li>\n\n\n\n
- Th\u1edf oxy khi gi\u1ea3m oxy m\u00e1u v\u00e0 gi\u1ea3m CO2<\/sub> m\u00e1u. <\/li>\n\n\n\n
- Th\u1edf m\u00e1y n\u00ean ch\u1ec9 \u0111\u1ecbnh th\u1eadn tr\u1ecdng v\u00ec n\u00f3 \u1ea3nh h\u01b0\u1edfng l\u00ean huy\u1ebft \u0111\u1ed9ng.<\/li>\n\n\n\n
- Th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng th\u1ea5p ( kho\u1ea3ng 6 ml\/kg n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 gi\u1eef cho \u00e1p l\u1ef1c b\u00ecnh nguy\u00ean cu\u1ed1i th\u00ec h\u00edt v\u00e0o <30 cm H2<\/sub>O.<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- Kh\u00e1ng \u0111\u1ed1ng ch\u00edch:\n
\n- PE nguy c\u01a1 cao ho\u1eb7c trung b\u00ecnh c\u00f3 ch\u1ec9 \u0111\u1ecbnh kh\u00e1ng \u0111\u00f4ng ti\u00eam trong khi ch\u1edd \u0111\u1ee3i k\u1ebft qu\u1ea3 c\u1eadn l\u00e2m s\u00e0ng. LWMH v\u00e0 Fondaparinux \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn h\u01a1n UFH v\u00ec nguy c\u01a1 ch\u1ea3y m\u00e1u v\u00e0 HIT th\u1ea5p. <\/li>\n\n\n\n
- UFH \u0111\u01b0\u1ee3c xem x\u00e9t khi t\u00e1i t\u01b0\u1edbi m\u00e1u th\u00ec \u0111\u1ea7u v\u1edbi ti\u00eau s\u1ee3i huy\u1ebft, b\u1ec7nh nh\u00e2n suy th\u1eadn n\u1eb7ng (CrCl < 30ml\/p) ho\u1eb7c b\u00e9o ph\u00ec.<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- Kh\u00e1ng \u0111\u00f4ng Vitamin K (VKA)\n
\n- VKA \u0111\u01b0\u1ee3c cho s\u1edbm c\u00f9ng l\u00fac v\u1edbi s\u1eed d\u1ee5ng kh\u00e1ng \u0111\u00f4ng ti\u00eam v\u00e0 k\u00e9o d\u00e0i \u00edt nh\u1ea5t l\u00e0 5 ng\u00e0y v\u00e0 cho \u0111\u1ebfn khi INR \u0111\u1ea1t 2-3 trong 2 ng\u00e0y li\u00ean ti\u1ebfp.<\/li>\n\n\n\n
- Warfarin n\u00ean kh\u1edfi \u0111\u1ea7u li\u1ec1u 10mg \u1edf ng\u01b0\u1eddi d\u01b0\u1edbi 60 tu\u1ed5i, n\u1ebfu tr\u00ean 60 tu\u1ed5i kh\u1edfi \u0111\u1ea7u 5 mg, \u0111i\u1ec1u ch\u1ec9nh d\u1ef1a v\u00e0o INR \u0111\u1ea1t t\u1eeb 2-3.<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- Kh\u00e1ng \u0111\u00f4ng u\u1ed1ng m\u1edbi\n
\n- Nh\u01b0 m\u1ed9t li\u1ec7u ph\u00e1p thay th\u1ebf ph\u1ed1i h\u1ee3p v\u1edbi kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng ti\u00eam thay cho VKA, Rivaroxaban 15mg ( x2\/ng\u00e0y trong 3 tu\u1ea7n), sau \u0111\u00f3 20mg, m\u1ed9t l\u1ea7n \/ ng\u00e0y<\/li>\n\n\n\n
- Nh\u01b0 m\u1ed9t li\u1ec7u ph\u00e1p thay th\u1ebf ph\u1ed1i h\u1ee3p v\u1edbi kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng ti\u00eam thay cho VKA, Apixapan 10mg (x2\/ng\u00e0y trong 7 ng\u00e0y), sau \u0111\u00f3 5mg, 2 l\u1ea7n\/ng\u00e0y<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- Ti\u00eau s\u1ee3i huy\u1ebft\n
\n- \u0110i\u1ec1u tr\u1ecb PE c\u1ea5p c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng v\u1edbi TSH h\u1ed3i ph\u1ee5c nhanh l\u01b0u th\u00f4ng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i h\u01a1n d\u00f9ng UFH \u0111\u01a1n thu\u1ea7n. <\/li>\n\n\n\n
- UFH n\u00ean ng\u01b0ng trong su\u1ed1t qu\u00e1 tr\u00ecnh truy\u1ec1n Streptokinase v\u00e0 Urokinase nh\u01b0ng c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng v\u1edbi rtPA. <\/li>\n\n\n\n
- \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc \u0111\u00f3 c\u00f3 d\u00f9ng LWMH ho\u1eb7c fondaparinux, \u1edf th\u1eddi \u0111i\u1ec3m thu\u1ed1c TSH b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng, UFH n\u00ean tr\u00ec ho\u00e3n sau 12 gi\u1edd d\u00f9ng LWMH cu\u1ed1i c\u00f9ng (li\u1ec1u 2 l\u1ea7n\/ng\u00e0y) ho\u1eb7c 24 gi\u1edd sau LWMH hay fondaparinux cu\u1ed1i c\u00f9ng (\u0111\u1ed1i v\u1edbi li\u1ec1u 1 l\u1ea7n\/ng\u00e0y ). 90% b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi TSH bi\u1ec3u hi\u1ec7n b\u1eb1ng c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng ho\u1eb7c si\u00eau \u00e2m trong v\u00f2ng 36 gi\u1edd. L\u1ee3i \u00edch th\u1ea5y r\u00f5 khi b\u1eaft \u0111\u1ea7u ch\u1eefa tr\u1ecb trong 48 gi\u1edd k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng, nh\u01b0ng TSH c\u00f3 th\u1ec3 v\u1eabn h\u1eefu \u00edch cho b\u1ec7nh nh\u00e2n kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng 6 \u2013 14 ng\u00e0y tr\u01b0\u1edbc<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n
Ph\u00f2ng ng\u1eeba<\/h2>\n\n\n\n\n- Kh\u00f4ng n\u1eb1m ho\u1eb7c ng\u1ed3i qu\u00e1 l\u00e2u, n\u00ean th\u01b0\u1eddng xuy\u00ean v\u1eadn \u0111\u1ed9ng.<\/li>\n\n\n\n
- Duy tr\u00ec m\u1ee9c c\u00e2n n\u1eb7ng h\u1ee3p l\u00fd.<\/li>\n\n\n\n
- N\u00ean m\u1eb7c qu\u1ea7n \u00e1o tho\u1ea3i m\u00e1i, kh\u00f4ng qu\u00e1 b\u00f3 s\u00e1t \u0111\u1ec3 tr\u00e1nh t\u00ecnh tr\u1ea1ng m\u00e1u kh\u00f4ng l\u01b0u th\u00f4ng.<\/li>\n\n\n\n
- Kh\u00f4ng h\u00fat thu\u1ed1c.<\/li>\n\n\n\n
- U\u1ed1ng thu\u1ed1c theo s\u1ef1 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129, kh\u00f4ng t\u1ef1 \u00fd mua thu\u1ed1c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ul>\n\n\n\n
B\u00e0i vi\u1ebft \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi BS.CKI. Nguy\u1ec5n Thanh D\u00f9ng \u2013 \u0110D. Tr\u01b0\u01a1ng Hu\u1ef3nh Nh\u01b0, khoa C\u1ea5p C\u1ee9u, B\u1ec7nh vi\u1ec7n Ho\u00e0n M\u1ef9 C\u1eedu Long.<\/p>\n\n\n\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/ins><\/strong><\/p>\n\n\n\nEur Heart J. (2014), ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC), 35, 3033\u2013308<\/p>\n","protected":false},"excerpt":{"rendered":"
T\u1ed5ng quan v\u1ec1 t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea5p T\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea5p (Pulmonary Embolism – PE) l\u00e0 t\u00ecnh tr\u1ea1ng m\u1ed9t ho\u1eb7c nhi\u1ec1u nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ecb t\u1eafc ngh\u1ebdn \u0111\u1ed9t ng\u1ed9t, ch\u1ee7 y\u1ebfu do huy\u1ebft kh\u1ed1i t\u1eeb t\u0129nh m\u1ea1ch s\u00e2u chi d\u01b0\u1edbi di chuy\u1ec3n l\u00ean ph\u1ed5i. \u0110\u00e2y l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa nguy […]<\/p>\n","protected":false},"author":14,"featured_media":273133,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1745],"tags":[],"class_list":["post-282345","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-benh-vien-hoan-my-cuu-long"],"acf":[],"_links":{"self":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/282345","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/comments?post=282345"}],"version-history":[{"count":1,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/282345\/revisions"}],"predecessor-version":[{"id":295828,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/282345\/revisions\/295828"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/media\/273133"}],"wp:attachment":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/media?parent=282345"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/categories?post=282345"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/tags?post=282345"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Bi\u1ec3u hi\u1ec7n t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i <\/h2>\n\n\n\n
Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a thuy\u00ean t\u1eafc ph\u1ed5i \u0111a d\u1ea1ng v\u00e0 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, d\u1ec5 b\u1ecf s\u00f3t. Tri\u1ec7u ch\u1ee9ng c\u1ee7a PE c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t v\u00e0 \u0111a d\u1ea1ng, t\u00f9y thu\u1ed9c v\u00e0o k\u00edch th\u01b0\u1edbc kh\u1ed1i t\u1eafc v\u00e0 t\u00ecnh tr\u1ea1ng tim ph\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n:<\/p>\n\n\n\n
- \n
- M\u1ed9t s\u1ed1 bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p:\n
- \n
- Kh\u00f3 th\u1edf \u0111\u1ed9t ng\u1ed9t (tri\u1ec7u ch\u1ee9ng ph\u1ed5 bi\u1ebfn nh\u1ea5t)<\/li>\n\n\n\n
- \u0110au ng\u1ef1c ki\u1ec3u m\u00e0ng ph\u1ed5i, t\u0103ng khi h\u00edt s\u00e2u ho\u1eb7c ho<\/li>\n\n\n\n
- Ho khan ho\u1eb7c ho ra m\u00e1u<\/li>\n\n\n\n
- Tim \u0111\u1eadp nhanh, nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u<\/li>\n\n\n\n
- H\u1ea1 huy\u1ebft \u00e1p, ch\u00f3ng m\u1eb7t, ng\u1ea5t x\u1ec9u (trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng)<\/li>\n\n\n\n
- T\u00edm t\u00e1i, \u0111\u1eb7c bi\u1ec7t \u1edf m\u00f4i v\u00e0 \u0111\u1ea7u chi<\/li>\n\n\n\n
- S\u1ed1t nh\u1eb9 ho\u1eb7c c\u1ea3m gi\u00e1c lo l\u1eafng, b\u1ed3n ch\u1ed3n kh\u00f4ng r\u00f5 l\u00fd do<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- Tri\u1ec7u ch\u1ee9ng \u00edt g\u1eb7p: ho m\u00e1u, thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i tinh th\u1ea7n (ng\u01b0\u1eddi gi\u00e0)<\/li>\n\n\n\n
- Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng: t\u1ee5t huy\u1ebft \u00e1p, nh\u1ecbp tim nhanh, cho\u00e1ng v\u00e1ng\/ng\u1ea5t, th\u1eadm ch\u00ed ng\u01b0ng tim<\/li>\n<\/ul>\n\n\n\n
Ch\u1ea9n \u0111o\u00e1n<\/h2>\n\n\n\n
Ch\u1ea9n \u0111o\u00e1n thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i: kh\u00f3, kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/p>\n\n\n\n
- \n
- D\u1ef1a tr\u00ean thang \u0111i\u1ec3m nguy c\u01a1 (Well, Geneva)<\/li>\n\n\n\n
- T\u0103ng D-dimer m\u00e1u<\/li>\n\n\n\n
- Ch\u1ee5p MDCT, ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea3n quang<\/li>\n\n\n\n
- Si\u00eau \u00e2m Doppler tim; si\u00eau \u00e2m t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi<\/li>\n<\/ul>\n\n\n\n
\u0110i\u1ec1u tr\u1ecb t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea5p t\u00ednh <\/h2>\n\n\n\n
- \n
- H\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng v\u00e0 h\u00f4 h\u1ea5p:\n
- \n
- Suy tim c\u1ea5p ph\u1ea3i dung v\u1eadn m\u1ea1ch (Dobutamine, Dopamin), c\u00f9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb t\u00e1i th\u00f4ng m\u1ea1ch b\u1eb1ng thu\u1ed1c hay th\u1ee7 thu\u1eadt.<\/li>\n\n\n\n
- Th\u1edf oxy khi gi\u1ea3m oxy m\u00e1u v\u00e0 gi\u1ea3m CO2<\/sub> m\u00e1u. <\/li>\n\n\n\n
- Th\u1edf m\u00e1y n\u00ean ch\u1ec9 \u0111\u1ecbnh th\u1eadn tr\u1ecdng v\u00ec n\u00f3 \u1ea3nh h\u01b0\u1edfng l\u00ean huy\u1ebft \u0111\u1ed9ng.<\/li>\n\n\n\n
- Th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng th\u1ea5p ( kho\u1ea3ng 6 ml\/kg n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 gi\u1eef cho \u00e1p l\u1ef1c b\u00ecnh nguy\u00ean cu\u1ed1i th\u00ec h\u00edt v\u00e0o <30 cm H2<\/sub>O.<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- Kh\u00e1ng \u0111\u1ed1ng ch\u00edch:\n
- \n
- PE nguy c\u01a1 cao ho\u1eb7c trung b\u00ecnh c\u00f3 ch\u1ec9 \u0111\u1ecbnh kh\u00e1ng \u0111\u00f4ng ti\u00eam trong khi ch\u1edd \u0111\u1ee3i k\u1ebft qu\u1ea3 c\u1eadn l\u00e2m s\u00e0ng. LWMH v\u00e0 Fondaparinux \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn h\u01a1n UFH v\u00ec nguy c\u01a1 ch\u1ea3y m\u00e1u v\u00e0 HIT th\u1ea5p. <\/li>\n\n\n\n
- UFH \u0111\u01b0\u1ee3c xem x\u00e9t khi t\u00e1i t\u01b0\u1edbi m\u00e1u th\u00ec \u0111\u1ea7u v\u1edbi ti\u00eau s\u1ee3i huy\u1ebft, b\u1ec7nh nh\u00e2n suy th\u1eadn n\u1eb7ng (CrCl < 30ml\/p) ho\u1eb7c b\u00e9o ph\u00ec.<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- Kh\u00e1ng \u0111\u00f4ng Vitamin K (VKA)\n
- \n
- VKA \u0111\u01b0\u1ee3c cho s\u1edbm c\u00f9ng l\u00fac v\u1edbi s\u1eed d\u1ee5ng kh\u00e1ng \u0111\u00f4ng ti\u00eam v\u00e0 k\u00e9o d\u00e0i \u00edt nh\u1ea5t l\u00e0 5 ng\u00e0y v\u00e0 cho \u0111\u1ebfn khi INR \u0111\u1ea1t 2-3 trong 2 ng\u00e0y li\u00ean ti\u1ebfp.<\/li>\n\n\n\n
- Warfarin n\u00ean kh\u1edfi \u0111\u1ea7u li\u1ec1u 10mg \u1edf ng\u01b0\u1eddi d\u01b0\u1edbi 60 tu\u1ed5i, n\u1ebfu tr\u00ean 60 tu\u1ed5i kh\u1edfi \u0111\u1ea7u 5 mg, \u0111i\u1ec1u ch\u1ec9nh d\u1ef1a v\u00e0o INR \u0111\u1ea1t t\u1eeb 2-3.<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- Kh\u00e1ng \u0111\u00f4ng u\u1ed1ng m\u1edbi\n
- \n
- Nh\u01b0 m\u1ed9t li\u1ec7u ph\u00e1p thay th\u1ebf ph\u1ed1i h\u1ee3p v\u1edbi kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng ti\u00eam thay cho VKA, Rivaroxaban 15mg ( x2\/ng\u00e0y trong 3 tu\u1ea7n), sau \u0111\u00f3 20mg, m\u1ed9t l\u1ea7n \/ ng\u00e0y<\/li>\n\n\n\n
- Nh\u01b0 m\u1ed9t li\u1ec7u ph\u00e1p thay th\u1ebf ph\u1ed1i h\u1ee3p v\u1edbi kh\u00e1ng \u0111\u00f4ng \u0111\u01b0\u1eddng ti\u00eam thay cho VKA, Apixapan 10mg (x2\/ng\u00e0y trong 7 ng\u00e0y), sau \u0111\u00f3 5mg, 2 l\u1ea7n\/ng\u00e0y<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- Ti\u00eau s\u1ee3i huy\u1ebft\n
- \n
- \u0110i\u1ec1u tr\u1ecb PE c\u1ea5p c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng v\u1edbi TSH h\u1ed3i ph\u1ee5c nhanh l\u01b0u th\u00f4ng \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i h\u01a1n d\u00f9ng UFH \u0111\u01a1n thu\u1ea7n. <\/li>\n\n\n\n
- UFH n\u00ean ng\u01b0ng trong su\u1ed1t qu\u00e1 tr\u00ecnh truy\u1ec1n Streptokinase v\u00e0 Urokinase nh\u01b0ng c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng v\u1edbi rtPA. <\/li>\n\n\n\n
- \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc \u0111\u00f3 c\u00f3 d\u00f9ng LWMH ho\u1eb7c fondaparinux, \u1edf th\u1eddi \u0111i\u1ec3m thu\u1ed1c TSH b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng, UFH n\u00ean tr\u00ec ho\u00e3n sau 12 gi\u1edd d\u00f9ng LWMH cu\u1ed1i c\u00f9ng (li\u1ec1u 2 l\u1ea7n\/ng\u00e0y) ho\u1eb7c 24 gi\u1edd sau LWMH hay fondaparinux cu\u1ed1i c\u00f9ng (\u0111\u1ed1i v\u1edbi li\u1ec1u 1 l\u1ea7n\/ng\u00e0y ). 90% b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi TSH bi\u1ec3u hi\u1ec7n b\u1eb1ng c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng ho\u1eb7c si\u00eau \u00e2m trong v\u00f2ng 36 gi\u1edd. L\u1ee3i \u00edch th\u1ea5y r\u00f5 khi b\u1eaft \u0111\u1ea7u ch\u1eefa tr\u1ecb trong 48 gi\u1edd k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng, nh\u01b0ng TSH c\u00f3 th\u1ec3 v\u1eabn h\u1eefu \u00edch cho b\u1ec7nh nh\u00e2n kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng 6 \u2013 14 ng\u00e0y tr\u01b0\u1edbc<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n
Ph\u00f2ng ng\u1eeba<\/h2>\n\n\n\n
- \n
- Kh\u00f4ng n\u1eb1m ho\u1eb7c ng\u1ed3i qu\u00e1 l\u00e2u, n\u00ean th\u01b0\u1eddng xuy\u00ean v\u1eadn \u0111\u1ed9ng.<\/li>\n\n\n\n
- Duy tr\u00ec m\u1ee9c c\u00e2n n\u1eb7ng h\u1ee3p l\u00fd.<\/li>\n\n\n\n
- N\u00ean m\u1eb7c qu\u1ea7n \u00e1o tho\u1ea3i m\u00e1i, kh\u00f4ng qu\u00e1 b\u00f3 s\u00e1t \u0111\u1ec3 tr\u00e1nh t\u00ecnh tr\u1ea1ng m\u00e1u kh\u00f4ng l\u01b0u th\u00f4ng.<\/li>\n\n\n\n
- Kh\u00f4ng h\u00fat thu\u1ed1c.<\/li>\n\n\n\n
- U\u1ed1ng thu\u1ed1c theo s\u1ef1 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129, kh\u00f4ng t\u1ef1 \u00fd mua thu\u1ed1c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ul>\n\n\n\n
B\u00e0i vi\u1ebft \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi BS.CKI. Nguy\u1ec5n Thanh D\u00f9ng \u2013 \u0110D. Tr\u01b0\u01a1ng Hu\u1ef3nh Nh\u01b0, khoa C\u1ea5p C\u1ee9u, B\u1ec7nh vi\u1ec7n Ho\u00e0n M\u1ef9 C\u1eedu Long.<\/p>\n\n\n\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/ins><\/strong><\/p>\n\n\n\n
Eur Heart J. (2014), ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC), 35, 3033\u2013308<\/p>\n","protected":false},"excerpt":{"rendered":"
T\u1ed5ng quan v\u1ec1 t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea5p T\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i c\u1ea5p (Pulmonary Embolism – PE) l\u00e0 t\u00ecnh tr\u1ea1ng m\u1ed9t ho\u1eb7c nhi\u1ec1u nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ecb t\u1eafc ngh\u1ebdn \u0111\u1ed9t ng\u1ed9t, ch\u1ee7 y\u1ebfu do huy\u1ebft kh\u1ed1i t\u1eeb t\u0129nh m\u1ea1ch s\u00e2u chi d\u01b0\u1edbi di chuy\u1ec3n l\u00ean ph\u1ed5i. \u0110\u00e2y l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa nguy […]<\/p>\n","protected":false},"author":14,"featured_media":273133,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1745],"tags":[],"class_list":["post-282345","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-benh-vien-hoan-my-cuu-long"],"acf":[],"_links":{"self":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/282345","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/comments?post=282345"}],"version-history":[{"count":1,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/282345\/revisions"}],"predecessor-version":[{"id":295828,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/posts\/282345\/revisions\/295828"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/media\/273133"}],"wp:attachment":[{"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/media?parent=282345"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/categories?post=282345"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/clients-previewhub.com\/hoanmy_wp\/wp-json\/wp\/v2\/tags?post=282345"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
- H\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng v\u00e0 h\u00f4 h\u1ea5p:\n